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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 endocarditis is cytoscopy induced?
Headaches and facial flushing; vasodilation in meninges and skin
S3 gallop; S2 to opening snap interval
Enterococci (e. faecalis)- found on genitalia area
Valproate

2. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
low in serum
glycerol kinase
When it invades the bm; carcinoma in situ

3. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Sydenham chorea
Tibial
Increase lymphatic drainage!
Medial circumflex artery; avascular necrosis

4. If a patient has higher levels of HbF - What does this mean?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Ceftriaxone; azithromycin
Think Hb deformation diseases
Relfex tachycardia; giving beta blockers

5. what kind of drug is sertraline? What is a common side effect?
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
low in serum
Sudden loss of muscle tone without loss of consciousness; narcolepsy
SSRI; erectile dysfunction

6. What can long term leg cast wearing cause?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Atrial
Duration and extent of disease
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

7. What causes curlings ulcers?
liver specific
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
LT (LTD4 - E4 - C4) - and Ach
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

8. What is normal fibrinogen levels?
Integration of viral DNA into genome of host hepatocytes
200-500
When it invades the bm; carcinoma in situ
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

9. within the right ventricle - What are maximum pressures? the pulm arter?
Vascular endothelium; protease
25; 25
Acute interstitial nephritis
Dissolved in plasma and attached to Hgb

10. what diseases can vit A be used to treat?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Measles and M3 AML`
Tzanck smear
Aromatase deficiency in child

11. What agonists reduce the gradient across the LV outflow tract?
Closer to head; closer to diaphragm
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Selective alpha 1 (increases SVR)

12. What is epleronone?
glycerol kinase
Sarcoid
Another type of aldosterone antagonist (like spironolactone)
Tissue redistribution (out of plasma) rather than metabolism

13. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
SVC and IVC; right below the aortic knob
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
II; I (I more abundant)

14. how does noise induced hearing loss occur?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
4 - 4 - 9
Trauma to stereociliated hair cells of the organ of corti
Increased reticulocytes

15. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
HSV and VZV
Coagulation factors are made in the liver
Susceptible; soluble (unable to be cultured in bile)

16. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
INTRApartum Abs (ampicillin/penicillin)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
low in serum
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

17. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
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)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
ZDV or AZT
When it invades the bm; carcinoma in situ

18. 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
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Bronchial dilation (bronchiectasis)

19. what immune deficiency causes recurrent neisseria infections?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Barium enema
MAC complex (C5b - C9 complement deficiency)
Inhaled animal dander allergens

20. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Duration and extent of disease
Hypothyroidism
Sickle cell; G6PD

21. What is Bortezomib and What is it used for?
Fibrosis; macrophages
Turners`
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Proteasome inhibitor; treatment for MM and waldenstroms

22. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Relfex tachycardia; giving beta blockers
Terminal bronchioles; small bronchi
Right heart failure
Kallmans

23. what virus causes pharyngoconjuctival fever?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Adeno
Around 70 (normal measured diastolic pressures); 9--
Ether and other organic solvents

24. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Prevent phagocytosis
Lateral; RV; RA; LV
SSRI; erectile dysfunction

25. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Inhaled animal dander allergens
Anti cholinergic effects of pupil dilation and lack of accomodation

26. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
In the extracellular space for collagen cross linking; zinc
Susceptible; soluble (unable to be cultured in bile)
gram positive organisms
Medullary

27. What is the most common cause of pyelonephritis in both adults and childre?
Radial nerve and deep brachial artery
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Diabetic microangiopathy
E. coli

28. what dissolves the lipid bilayer of a viral envelope?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hexokinase
Joints d/t increased purine production and thus uric acid production
Ether and other organic solvents

29. what drugs causes the red man syndrome? how does it occur?
Inhibits it
Vancomycin; histamine mediated
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

30. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Normal; low
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
Highly negative resting potential

31. What is a cord factor and Which bugs have it? How do they appear on culture?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Prevents hepatic VLDL production
GI tract; mood!
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

32. What is the Na/Ca exchange used for?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
To pump calcium out in cardiac myocytes so that relaxation occurs
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Increases

33. what enzyme converts procarcinogens into carcinogens?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Chrom 8
P450 mitochondrial monooxygenase
Hereditary angioedema; ACE inhibitors

34. What does p53 do? what chrom is it on?
No; MRI
SSRI; erectile dysfunction
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

35. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Measure of depth invasion (vertical!)
Duration and extent of disease
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

36. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Vancomycin
P53 mutation; AD
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

37. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
No; MRI
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)
In the extracellular space for collagen cross linking; zinc

38. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Lateral; RV; RA; LV
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
S. aureus
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

39. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Standing suddenly from supine position; valsalva maneuver
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

40. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
E. coli; staphylococcus saprophyticus
Biphosphonate
Coagulation factors are made in the liver

41. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Another type of aldosterone antagonist (like spironolactone)
Common peroneal; bony fractures and compression; sciatic
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Terminal bronchioles; small bronchi

42. where are Beta 1 receptors found?
Hypothyroidism
On cardiac tissue and renal juxtaglomerular cells
APP on chrom 21 (this is why downs more susceptible)
G to T in p53; HCC

43. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Prepatellar
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
Chrom 8
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

44. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
facultative intracellular
Bronchial dilation (bronchiectasis)
Excessive collagen formation during tissue repair in susceptible individuals

45. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
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
RBC mass; epo levels (secondary has high)
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
Measure of depth invasion (vertical!)

46. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Normally close to systolic
Headaches and facial flushing; vasodilation in meninges and skin
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

47. What is congestive hepatomegaly specific for?
Right heart failure
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
SS +rNA

48. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Regular insulin (Not fast acting - regular better)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

49. What does prolonged PT indicated? aPTT? bleeding time?
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)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Extrinsic def; instrinsic def; platelet def
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

50. which RPGN is also called pauci immune GN? why?
No; MRI
Enterococci (e. faecalis)- found on genitalia area
ANCA because of lack of Ig and C3 deposits on IF
Echinococcus granulosus; anaphylaxis