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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 is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
GI tract; mood!
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Hereditary angioedema; ACE inhibitors

2. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Curlings ulcers
liver specific
Amiloride - spironolactone - triamterene

3. What type of drug is alendronate?
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)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Biphosphonate
4 - 4 - 9

4. How do bradykinin - C3a and C5a cause edema?
Reticulocytes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
By vascular permeability and vasodilation

5. a patient fearing all white coats is a phenomenon of what?
Rabies encephalitis from cave bats; rabies killed vaccines
Classical conditioning
4 - 4 - 9
Radial nerve and deep brachial artery

6. 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
S3 gallop; S2 to opening snap interval
Anti centromere; anti DNA topoisomerase
Enterococci (e. faecalis)- found on genitalia area

7. what virus causes pharyngoconjuctival fever?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Normal; low
Phencyclidine (PCP)
Adeno

8. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
HSV ( also in utero: chlymadia - neisseria - group B strep)
TSh (in testicular tumors can cause hyperthyroidism)
Inhaled animal dander allergens

9. in the LV and aorta - What are the pressures?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Not lined by epithelium
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Normally close to systolic

10. how long is substance P? What does it do?
Southern - western
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
11 aa polypeptide; pain NT in CNS and PNS
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. Which is slower AV node or ventricular muscle?
Relfex tachycardia; giving beta blockers
Hypo or hyper pigmentations; after tanning
AV node slowest - to allow time for diastole
4 - 4 - 9

12. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Curlings ulcers
manifestations - congenital (stretching of periventricular pyrimadal fibers)
AV node slowest - to allow time for diastole
indomethacin

13. What are two common side effects of both acute and long acting nitrates? What causes them?
FGF and VEGF
Medial circumflex artery; avascular necrosis
Think Hb deformation diseases
Headaches and facial flushing; vasodilation in meninges and skin

14. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Increase; decreased
Vertical diplopia
Mean greater than median greater than mode
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

15. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

16. What is hyaline arteriosclerosis usually a sign of ?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Demargination of neutrophils from the vessel walls
Diabetic microangiopathy
Curlings ulcers

17. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Dissolved in plasma and attached to Hgb
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

18. which cells produce surfactant? which ones mediate gas exchange?
Brief psychotic disorder; schizophreniform; schizophrenia
Normally close to systolic
II; I (I more abundant)
Extrinsic def; instrinsic def; platelet def

19. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Tzanck smear
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Gluteus maximus; difficulty getting up from seated position and climbing chair

20. what defines hypoxemia?
Squatting - sitting - lying supine - passive leg raising
Boiling - bleach - formalin - UV irradiation
Increases cytokine production
SaO2 <92%

21. What is Tzanck smear used to detect?
Drink plenty of fluids
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Prevent phagocytosis
HSV and VZV

22. prostaglandin synthesis keeps...
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
PDA open
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Anti centromere; anti DNA topoisomerase

23. Which is faster atrial muscle or ventricular muscle?
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
facultative intracellular
Pan colitis and right sided colitis (more than left sided and proctitis)
Atrial

24. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
46 - 4N; 23 2N
P53 mutation; DCC is also required for adenoma to carcinoma
GI malignancies and Insulin resistance (acromegal for ex)
Normal; low

25. What are some side effects seen in TCAs?
Anti cholinergic effects of pupil dilation and lack of accomodation
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Localized dermatologic pain that persists for more than one month after zoster eruption
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

26. What are the long term consequences of hydrocephalus?
SVC and IVC; right below the aortic knob
IgE
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Acute interstitial nephritis

27. What is medullary sponge kidney disease and how does it present? What does it lead to?
SVT; increases vagal tone; rectus abdominis
Bile soluble which means they are bile sensitive
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)
INTRApartum Abs (ampicillin/penicillin)

28. What effects does cortisol have on catecholamines?
Abnormal closing of the urethral folds
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
11 aa polypeptide; pain NT in CNS and PNS
By vascular permeability and vasodilation

29. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Leukotriene precursor and does neutrophil chemotaxis
Covalent (between two cysteines)- allows protein to withstand denaturation
ATP binding (resets the myosin head to contract again for next binding)

30. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Insulin like growth factor 1 (just another name)
Leukotriene precursor and does neutrophil chemotaxis
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

31. What can cause virilization of a mother during pregnancy?
P450 mitochondrial monooxygenase
Aromatase deficiency in child
Sydenham chorea
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

32. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Increases
transcription activation/suppression
Kallmans

33. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
IgE
Valproate
Brief psychotic disorder; schizophreniform; schizophrenia
Large stroke volumes with ventricular contraction; aortic regurg

34. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Bile soluble which means they are bile sensitive
RR-1/RR
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

35. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nonsense; mRNA processing
hyponatremia (aldosterone activation equilibrates body volume)
Aromatase deficiency in child

36. When is an S4 sound normal?
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
INTRApartum Abs (ampicillin/penicillin)
Well trained athletes and children
Terminal bronchioles; small bronchi

37. what drugs causes the red man syndrome? how does it occur?
Abnormal closing of the urethral folds
Bronchogenic carcinoma
Vancomycin; histamine mediated
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

38. What does the severity of leprosy depend on?
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
frameshift mutations (missense is substitution)
Strength of cell mediated immune response
25; 25

39. Where does conjugation of bilirubin take place?
Vascular endothelium; protease
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Reiter syndrome; B27
In ER of bile canaliculi

40. why does hypothyroidism cause increased CPK levels?
P450 mitochondrial monooxygenase
Medullary
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
MAC complex (C5b - C9 complement deficiency)

41. What is extraocular muscle weakness a common symptom of?
GI malignancies and Insulin resistance (acromegal for ex)
Reticulocytes
Trauma to stereociliated hair cells of the organ of corti
Myasthenia gravis

42. Acyl coA synthetase is not...
Elastance
liver specific
Strength of cell mediated immune response
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

43. In what form are mitochondrial DNA? What do they transcribe?
HSV and VZV
C3 decreased after 5-10 days; sulfonamides
Circular - outside nucleus; transport proteins - rRNA - tRNA
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

44. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Measles and M3 AML`
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Abnormal closing of the urethral folds

45. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
I is more benign and can present later in adulthood
Bronchogenic carcinoma
Fibronectin - laminin - collagen
Anti - apoptotic (prevents going into apoptosis)- 18; 14

46. What is the mutation type in thalassemias? what process is defective because of this?
Close but purkinje system to ensure contraction in a bottom up fashion
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
Nonsense; mRNA processing
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)

47. How do you treat gonococcal infection? chlymadia?
Boiling - bleach - formalin - UV irradiation
Become beta pleated and then form neurofibrillary tangle!
Smoking
Ceftriaxone; azithromycin

48. What type of calcium channels dictate the plateau in cardiac myocyte?
Mean greater than median greater than mode
Right heart failure
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Dihydropyridine sensitive Ca channels (L type)

49. When is acid phosphatase elevated (Name two times)?
Appetite suppressants
Acute gastric mucosal defects (superficial or full thickness)
Thymic tumor
Prostate tumor and increased osteoclast activity

50. What are the potassium sparing diuretics?
Little effect on cell and no change
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Amiloride - spironolactone - triamterene
Fibronectin - laminin - collagen