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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 ulcers arising in the proximal duodenum in association with severe trauma or burns called?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Curlings ulcers
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
MAO inhibitors; wine and cheese

2. What is the most common cause of pyelonephritis in both adults and childre?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Hyperkalemia; potassium sparing diuretics - potassium supplements
E. coli
C3 decreased after 5-10 days; sulfonamides

3. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Right heart failure
Terminal bronchioles; small bronchi
G to T in p53; HCC
Anterior nares

4. how does noise induced hearing loss occur?
glycerol kinase
Trauma to stereociliated hair cells of the organ of corti
Headaches and facial flushing; vasodilation in meninges and skin
RER; copper

5. What are three symptoms in s.typhi?
Right heart failure
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Prevent phagocytosis

6. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Congenital hypothyroidism - downs - amyloidosis - acromegaly
RR-1/RR

7. why are pregnant predisposed to cholelithiasis?
AV node slowest - to allow time for diastole
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
SSRI; erectile dysfunction

8. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
T test; chi squared
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

9. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Decreases both
Vagus nerve stimulation
Fibronectin - laminin - collagen
CGD; t cell dysfxn (diGeorge)

10. What is hypospadias caused by?
Abnormal closing of the urethral folds
Recurrent larygneal
Around 70 (normal measured diastolic pressures); 9--
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

11. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
SSRI
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
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Vancomycin

12. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Common peroneal; bony fractures and compression; sciatic
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
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

13. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Ig A deficiency
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
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
E. coli; staphylococcus saprophyticus

14. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Nocardia
Because gamma chains replace beta chains and then gamma chain formation wanes
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

15. What can nitrates lead to that is bad for angina therapy? How do you counter this?
APP on chrom 21 (this is why downs more susceptible)
Relfex tachycardia; giving beta blockers
Paramyxo and influenza
Ether and other organic solvents

16. What does anti phospholipid syndrome in SLE patients predispose them to?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
25; 25
Multiple miscarriages d/t hypercoaguability
In the extracellular space for collagen cross linking; zinc

17. what color pigmentations are caused by malassezia furfur? when do they become more visible?
No; MRI
Squatting - sitting - lying supine - passive leg raising
Hypo or hyper pigmentations; after tanning
Ether and other organic solvents

18. what drugs causes the red man syndrome? how does it occur?
Bronchial dilation (bronchiectasis)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vancomycin; histamine mediated
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

19. other than in pyelonephritis - where else are WBC casts seen?
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
Thymic tumor
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Acute interstitial nephritis

20. biotin is used By what in tissues responsible for gluconeogenesis
Amiadarone
As a CO2 carrier with the carboxylase enzyme
RER; copper
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

21. What is the mcc of extrinsic allergic asthma?
Drug induced interstitial nephritis
Inhaled animal dander allergens
Prepatellar
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

22. What is epleronone?
Closer to head; closer to diaphragm
Insulin like growth factor 1 (just another name)
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
Another type of aldosterone antagonist (like spironolactone)

23. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Sickle cell; G6PD
TCAs and prazosin
Recurrent larygneal

24. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
gram positive organisms
E. coli; staphylococcus saprophyticus
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Demargination of neutrophils from the vessel walls

25. What does p53 do? what chrom is it on?
Susceptible; soluble (unable to be cultured in bile)
Highly negative resting potential
RBF= PAH clearance/(1- hematocrit)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

26. 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
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Another type of aldosterone antagonist (like spironolactone)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

27. name three pathological states that present with large tongues.
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Chrom 8
Kallmans

28. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
No; yes
Anti - apoptotic (prevents going into apoptosis)- 18; 14

29. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
RER; RER
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

30. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
In the extracellular space for collagen cross linking; zinc
MAO inhibitors; wine and cheese
ANCA because of lack of Ig and C3 deposits on IF

31. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increase; decreased
Decreases both
Apocrine; eccrine

32. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
NF- KB; responsible for cytokine production
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Radial nerve damage

33. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
(urine PAH x urine flow rate)/plasma PAH
Inhaled animal dander allergens
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Thymic tumor

34. what defines hypoxemia?
DIC; TTP- HUS dont bleed that much
Multiple miscarriages d/t hypercoaguability
SaO2 <92%
Elastance

35. PDAs are often asymptomatic. How do you treat?
Little effect on cell and no change
Integration of viral DNA into genome of host hepatocytes
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
indomethacin

36. How can renal blood flow be calculated from RPF?
Bronchial dilation (bronchiectasis)
Serum creatine kinase; reperfusion injury causes necrosis
RBF= PAH clearance/(1- hematocrit)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

37. which antiarrythmic is associated with blue gray discoloration ?
APP on chrom 21 (this is why downs more susceptible)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Amiadarone
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

38. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
E. coli; staphylococcus saprophyticus
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
SSRI

39. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Turners`

40. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
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)
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
Sydenham chorea
Rabies encephalitis from cave bats; rabies killed vaccines

41. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Decreases both
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Downs; regurgitant AV valves - ASDs
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

42. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Biphosphonate
Vascular endothelium; protease
Regular insulin (Not fast acting - regular better)

43. what dissolves the lipid bilayer of a viral envelope?
RBF= PAH clearance/(1- hematocrit)
Single adenomatous ones
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)
Ether and other organic solvents

44. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Initiation - pointing; pincer grasp; walking; mama/dada
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

45. What is a clara cell?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Octreotide
Serum FFA and serum triglyceride levels

46. What type of endocarditis is cytoscopy induced?
Increases cytokine production
Enterococci (e. faecalis)- found on genitalia area
Decreases both
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

47. What is Bortezomib and What is it used for?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
P450 mitochondrial monooxygenase
Proteasome inhibitor; treatment for MM and waldenstroms
The term used to describe decreased drug responsiveness with repeated administration

48. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
SSRI
Susceptible; soluble (unable to be cultured in bile)
Brief psychotic disorder; schizophreniform; schizophrenia
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

49. What does Rb protein do? what chrom is it on?
Because of vasodiation to skeletal muscles
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Multiple miscarriages d/t hypercoaguability

50. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Radial nerve and deep brachial artery
Amiloride - spironolactone - triamterene
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Because of the low output from heart failure - they will have increased aldosterone levels