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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 causes release of myosin head from the actin filament?
CMV - HSV 1 - Candida
I is more benign and can present later in adulthood
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
ATP binding (resets the myosin head to contract again for next binding)

2. where exactly is ACE expressed in the lungs? What type of enzyme is it?
E. coli; staphylococcus saprophyticus
Vascular endothelium; protease
differentiate
Leukotriene precursor and does neutrophil chemotaxis

3. is Rifampin ever used as monotherapY? why either way?
CMV - HSV 1 - Candida
Increases cytokine production
Trochlear nerve (IV); abducens nerve (VI)
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

4. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Purkinje system; AV node
Recurrent larygneal
To pump calcium out in cardiac myocytes so that relaxation occurs
Hexokinase

5. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
TSh (in testicular tumors can cause hyperthyroidism)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Abnormal closing of the urethral folds
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

6. What is the difference between additive and synergistic?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
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
Turners`

7. how long is substance P? What does it do?
Pan colitis and right sided colitis (more than left sided and proctitis)
11 aa polypeptide; pain NT in CNS and PNS
Classical conditioning
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

8. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Phencyclidine (PCP)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
glycerol kinase

9. do Class IC agents prolong the QT interval?
No
Tibial
Trochlear nerve (IV); abducens nerve (VI)
Think Hb deformation diseases

10. What is the preferred treatment for DKA?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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
Regular insulin (Not fast acting - regular better)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

11. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Sarcoid
Right before diastole (filling begins)

12. What is the most common initital symptom of ADPKD? what else?
RER; RER
Intussusception
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Purkinje system; AV node

13. What is difference between Arnold Chiari type I and II?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
I is more benign and can present later in adulthood
Medial circumflex artery; avascular necrosis

14. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Amiloride - spironolactone - triamterene
Gluteus maximus; difficulty getting up from seated position and climbing chair
Anterior circumflex (and axillary nerve)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

15. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Covalent (between two cysteines)- allows protein to withstand denaturation
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Relfex tachycardia; giving beta blockers
Medial circumflex artery; avascular necrosis

16. what vessel would a fracture to the neck of the of the humerus damage?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
SaO2 <92%
Anterior circumflex (and axillary nerve)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

17. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
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
SVC and IVC; right below the aortic knob
Acute interstitial nephritis
APP on chrom 21 (this is why downs more susceptible)

18. within the right atrium - What is the maximum pressure? left atrium?
46 - 4N; 23 2N
DIC; TTP- HUS dont bleed that much
8; 12
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

19. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
transcription activation/suppression
Excessive collagen formation during tissue repair in susceptible individuals
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Increase; decreased

20. What does sustained hand grip do to the C/V system?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Classical conditioning
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

21. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Chorda tympani branch
Covalent (between two cysteines)- allows protein to withstand denaturation
RER; copper

22. other than proteinuria - What can cause foamy froathy urine?
Extrinsic def; instrinsic def; platelet def
Bile salt accumulation in urine
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

23. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
MAO inhibitors; wine and cheese
T test; chi squared
Around 70 (normal measured diastolic pressures); 9--
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

24. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Fibronectin - laminin - collagen
In the extracellular space

25. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Echinococcus granulosus; anaphylaxis
frameshift mutations (missense is substitution)
HSV ( also in utero: chlymadia - neisseria - group B strep)

26. What are the primary determinants of colon cancer risk in UC patients
P53 mutation; AD
By vascular permeability and vasodilation
Duration and extent of disease
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

27. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
women
HSV ( also in utero: chlymadia - neisseria - group B strep)

28. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
GI malignancies and Insulin resistance (acromegal for ex)
Myasthenia gravis

29. What is somatomedin C?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Sickle cell; G6PD
Insulin like growth factor 1 (just another name)
Kallmans

30. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
differentiate
Phencyclidine (PCP)
gram positive organisms

31. What is the triad seen in pre eclampsia?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
No and yes
Hypertension - edema - and proteinuria

32. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
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
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Demargination of neutrophils from the vessel walls

33. What would a deflection of the membrane potential to near zero indicate?
Myasthenia gravis
Acute gastric mucosal defects (superficial or full thickness)
Octreotide
Increase in permeability of two ions with equal and opposite equilibrium potentials

34. What is a cell surface marker seen in liver angiosarcoma?
RER; RER
Skin flushing and warmth; prostaglandins; give with aspirin
LT (LTD4 - E4 - C4) - and Ach
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

35. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Fat - fertile - forty - female
V fib; v. failure
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

36. What is suggestive of complete central DI?
LT (LTD4 - E4 - C4) - and Ach
RER; copper
Brief psychotic disorder; schizophreniform; schizophrenia
Increase by 50% in urine osmolality

37. what hernia has a similar mechanism to hydrocele?
Folic acid treatment!
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Think Hb deformation diseases
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

38. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Vagus (auricular branch); vasovagal syncope!
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Medullary
Neisseria induced small cell vasculitis (including hands and soles)

39. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
SS +rNA
S. saprophyticus - and s. epidermidis; novobiocin
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

40. how can HAV be inactivated?
In the extracellular space
Valproate
Skin flushing and warmth; prostaglandins; give with aspirin
Boiling - bleach - formalin - UV irradiation

41. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Class I
Initiation - pointing; pincer grasp; walking; mama/dada
No and yes
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

42. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Class I

43. which are the only glycosylated proteins in HIV virus?
The term used to describe decreased drug responsiveness with repeated administration
Common peroneal; bony fractures and compression; sciatic
Env genes (for getting into target cells)
Regular insulin (Not fast acting - regular better)

44. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Fibrosis; macrophages
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Curlings ulcers
Anti cholinergic effects of pupil dilation and lack of accomodation

45. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Fibrosis; macrophages
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
Minimal change disease
Cluster

46. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Gluteus maximus; difficulty getting up from seated position and climbing chair
DIC; TTP- HUS dont bleed that much
Radial nerve damage

47. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Acute interstitial nephritis
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Terminal bronchioles; small bronchi
Rabies encephalitis from cave bats; rabies killed vaccines

48. What type of calcium channels dictate the plateau in cardiac myocyte?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Skin flushing and warmth; prostaglandins; give with aspirin
Dihydropyridine sensitive Ca channels (L type)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

49. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
C3 decreased after 5-10 days; sulfonamides

50. 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
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Aromatase deficiency in child