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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 stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Valproate
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)
Radial nerve and deep brachial artery

2. how can HAV be inactivated?
TSh (in testicular tumors can cause hyperthyroidism)
Decreases both
Boiling - bleach - formalin - UV irradiation
Pulmonic and systemic!

3. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
Gluteus medius and minimus; positive trendelenberg
Radial nerve and deep brachial artery
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

4. if there are keratin swirls does that mean well or poorly differentiated?
RR-1/RR
Well
ATP binding (resets the myosin head to contract again for next binding)
RER; copper

5. where are Beta 1 receptors found?
Insulin like growth factor 1 (just another name)
indomethacin
On cardiac tissue and renal juxtaglomerular cells
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

6. other than increasing HDL levels - what else does niacin do?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Brief psychotic disorder; schizophreniform; schizophrenia
Pan colitis and right sided colitis (more than left sided and proctitis)
Prevents hepatic VLDL production

7. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Inhaled animal dander allergens
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Skin flushing and warmth; prostaglandins; give with aspirin
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

8. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Amiadarone
Inactivates kallikrein which activates kininogen into bradykinin
Inhaled animal dander allergens

9. Acyl coA synthetase is not...
liver specific
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Medial circumflex artery; avascular necrosis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

10. What can long term leg cast wearing cause?
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
Thymic tumor
Susceptible; soluble (unable to be cultured in bile)
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

11. Which is faster purkinje system or atrial muscle?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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
Vancomycin; histamine mediated
Close but purkinje system to ensure contraction in a bottom up fashion

12. What do you treat s. epidermidis with?
Barium enema
Headaches and facial flushing; vasodilation in meninges and skin
Vancomycin
I is more benign and can present later in adulthood

13. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Bile salt accumulation in urine
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Reiter syndrome; B27
Increase in permeability of two ions with equal and opposite equilibrium potentials

14. which has better side effect profile - SSRI or TCA?
SSRI
Sickle cell; G6PD
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
ZDV or AZT

15. other than parvo B19 - what else is associated with red cell aplasia?
Well trained athletes and children
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Thymic tumor
Radial nerve damage

16. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Vancomycin; histamine mediated
Octreotide
APP on chrom 21 (this is why downs more susceptible)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

17. What is a keloid?
Initiation - pointing; pincer grasp; walking; mama/dada
Aromatase deficiency in child
Excessive collagen formation during tissue repair in susceptible individuals
glycerol kinase

18. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Turners`
Selective alpha 1 (increases SVR)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

19. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
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
ANCA because of lack of Ig and C3 deposits on IF
Increases cytokine production
Because of vasodiation to skeletal muscles

20. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Standing suddenly from supine position; valsalva maneuver
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

21. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Elevated GGT and macrocytosis
E6 and E7 of HPV knock off p53 and Rb suppressor genes
On cardiac tissue and renal juxtaglomerular cells
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

22. Is there edema in primary Conns? secondary hyperaldosteronism? why?
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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Downs; regurgitant AV valves - ASDs
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

23. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Joints d/t increased purine production and thus uric acid production
HSV ( also in utero: chlymadia - neisseria - group B strep)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

24. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Coagulation factors are made in the liver
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
E. coli

25. What is mcc of death pre hospital phase of MI? in hospital phase?
Sickle cell; G6PD
Minimal change disease
Bronchial dilation (bronchiectasis)
V fib; v. failure

26. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Recurrent larygneal
differentiate
Well

27. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
Rabies encephalitis from cave bats; rabies killed vaccines
TSh (in testicular tumors can cause hyperthyroidism)
E. coli; staphylococcus saprophyticus

28. What is used to compare means? categorical outcomes?
Bile soluble which means they are bile sensitive
Excessive collagen formation during tissue repair in susceptible individuals
Enterococci (e. faecalis)- found on genitalia area
T test; chi squared

29. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Apocrine; eccrine
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
Lateral; RV; RA; LV

30. What is the diagnosis in delayed puberty plus anosmia?
DIC; TTP- HUS dont bleed that much
Kallmans
Aromatase deficiency in child
11 aa polypeptide; pain NT in CNS and PNS

31. What is the mcc of extrinsic allergic asthma?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Inhaled animal dander allergens
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Reiter syndrome; B27

32. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
frameshift mutations (missense is substitution)
Hyperkalemia; potassium sparing diuretics - potassium supplements

33. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
(urine PAH x urine flow rate)/plasma PAH
Barium enema
Bile soluble which means they are bile sensitive

34. which RPGN is also called pauci immune GN? why?
Atrial
ANCA because of lack of Ig and C3 deposits on IF
Underestimation of gestational age
Acute interstitial nephritis

35. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
FGF and VEGF
Class I
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

36. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Primary
Well trained athletes and children
Drug induced interstitial nephritis

37. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
hyponatremia (aldosterone activation equilibrates body volume)
Common peroneal; bony fractures and compression; sciatic
Pulmonic and systemic!
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

38. what bursa is affected when on knees like a maid/gardner?
Kallmans
8 (myc protein) with 2 - 14 - 22 (iG chains)
Prepatellar
Clindamycin; covers anaerobic oral flora and aerobic bacteria

39. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Around 70 (normal measured diastolic pressures); 9--
gram positive organisms
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

40. What is used to treat heparin toxicity?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Protamine sulfate

41. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Decreases both
Prepatellar
Purkinje system; AV node

42. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

43. When is acid phosphatase elevated (Name two times)?
women
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Prostate tumor and increased osteoclast activity
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

44. on which chromosome is wilms tumor found?
Highly negative resting potential
Increase by 50% in urine osmolality
RBF= PAH clearance/(1- hematocrit)
11

45. What are diastolic (lowest) pressures in aorta? LV?
Syringomelia
Medial circumflex artery; avascular necrosis
Well trained athletes and children
Around 70 (normal measured diastolic pressures); 9--

46. What are some side effects seen in TCAs?
Radial nerve and deep brachial artery
differentiate
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

47. which nerve provides innervation for plantar flexion and inversion?
Tibial
Little effect on cell and no change
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
Inhibits it

48. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
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
Excessive collagen formation during tissue repair in susceptible individuals
Increase by 50% in urine osmolality

49. What is best to prevent GBS infection in a baby?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
INTRApartum Abs (ampicillin/penicillin)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
CGD; t cell dysfxn (diGeorge)

50. What does extended consumption of appetite suppressants lead to?
frameshift mutations (missense is substitution)
Neisseria induced small cell vasculitis (including hands and soles)
Echinococcus granulosus; anaphylaxis
Pulmonary hypertension