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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. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
TCAs and prazosin
Tibial
Vancomycin; histamine mediated
Skin flushing and warmth; prostaglandins; give with aspirin

2. h1 receptor anatagonists are not effective in treatment of asthma only for...
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Strength of cell mediated immune response
chronic urticaria and allergic symptoms
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

3. Where does conjugation of bilirubin take place?
Bronchogenic carcinoma
Inhaled animal dander allergens
In ER of bile canaliculi
P450 mitochondrial monooxygenase

4. IL4 is used for isotypye switching to what?
IgE
Localized dermatologic pain that persists for more than one month after zoster eruption
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

5. a patient fearing all white coats is a phenomenon of what?
SVT; increases vagal tone; rectus abdominis
Varying; erythema nodosum is common
Classical conditioning
Think Hb deformation diseases

6. What are fenfluramine - phentermine?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Appetite suppressants
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
LT (LTD4 - E4 - C4) - and Ach

7. What causes curlings ulcers?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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

8. do Class IC agents prolong the QT interval?
Rabies encephalitis from cave bats; rabies killed vaccines
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Superior larygeal; cricothyroid; recurrent laryngeal
No

9. on which chromosome is wilms tumor found?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
11
Primary
Nocardia

10. What can worse neurologic dysfunction in cobalamic def?
Become beta pleated and then form neurofibrillary tangle!
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Folic acid treatment!
HSV and VZV

11. What triggers the neoplastic changes that are associated with HBV infecton?
Pulmonic and systemic!
Closer to head; closer to diaphragm
Integration of viral DNA into genome of host hepatocytes
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

12. which cells produce surfactant? which ones mediate gas exchange?
Measles and M3 AML`
Initiation - pointing; pincer grasp; walking; mama/dada
II; I (I more abundant)
Reticulocytes

13. What is used to prevent vertical transmission of HIV?
I is more benign and can present later in adulthood
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
S3 gallop; S2 to opening snap interval
ZDV or AZT

14. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
SaO2 <92%
Serum creatine kinase; reperfusion injury causes necrosis
Atrial

15. In what population does cholelithiasis occur?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
G to T in p53; HCC
Radial nerve damage
Fat - fertile - forty - female

16. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
low in serum
HSV and VZV
RER; copper

17. what bursa is affected when on knees like a maid/gardner?
Bile soluble which means they are bile sensitive
Prepatellar
Atrial
Octreotide

18. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
S. saprophyticus - and s. epidermidis; novobiocin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

19. neisseria are...
Dihydropyridine sensitive Ca channels (L type)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Standing suddenly from supine position; valsalva maneuver
facultative intracellular

20. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
I is more benign and can present later in adulthood
Underestimation of gestational age
11

21. What is the most common initital symptom of ADPKD? what else?
low in serum
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Apocrine; eccrine
Inactivates kallikrein which activates kininogen into bradykinin

22. which opponens muscle does ulnar innervate?
Underestimation of gestational age
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)
Adductor
Around 70 (normal measured diastolic pressures); 9--

23. who bleed more DIC or TTP- HUS patients?
8 (myc protein) with 2 - 14 - 22 (iG chains)
SSRI
In the extracellular space
DIC; TTP- HUS dont bleed that much

24. What is capacitance inversely proportional to?
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
SSRI
Elastance
TCAs and prazosin

25. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Strength of cell mediated immune response
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)
Headaches and facial flushing; vasodilation in meninges and skin
Brief psychotic disorder; schizophreniform; schizophrenia

26. What is the mc malignancy in asbestosis?
Curlings ulcers
Varying; erythema nodosum is common
Bronchogenic carcinoma
Kallmans

27. What pulmonary structural change can kartageners syndrome cause?
Normal; low
Bronchial dilation (bronchiectasis)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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

28. what happens to capacitance with age?
ZDV or AZT
Downs; regurgitant AV valves - ASDs
...
Common peroneal; bony fractures and compression; sciatic

29. What is hyaline arteriosclerosis usually a sign of ?
Brief psychotic disorder; schizophreniform; schizophrenia
No (unlike adenomyosis); yes
Hydrogen bonds dictate alpha or beta structure
Diabetic microangiopathy

30. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Large stroke volumes with ventricular contraction; aortic regurg
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Acute gastric mucosal defects (superficial or full thickness)

31. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Pulmonic and systemic!
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
HSV ( also in utero: chlymadia - neisseria - group B strep)

32. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
(urine PAH x urine flow rate)/plasma PAH
Minimal change disease

33. Which is faster atrial muscle or ventricular muscle?
Closer to head; closer to diaphragm
Atrial
INTRApartum Abs (ampicillin/penicillin)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

34. What is the cause of rapid plasma decay of thiopental?
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
Octreotide
8; 12
Tissue redistribution (out of plasma) rather than metabolism

35. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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36. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Ether and other organic solvents
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Trochlear nerve (IV); abducens nerve (VI)

37. what diseases can vit A be used to treat?
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
Squatting - sitting - lying supine - passive leg raising
Measles and M3 AML`
Demargination of neutrophils from the vessel walls

38. What is the fibrinogen level in patient with TTP- HUS? DIC?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Normal; low
Increases
SVC and IVC; right below the aortic knob

39. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Superior larygeal; cricothyroid; recurrent laryngeal
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Appetite suppressants

40. What is a cell surface marker seen in liver angiosarcoma?
hyponatremia (aldosterone activation equilibrates body volume)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

41. what protects the resting heart from arrhythmias?
Atrial
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Highly negative resting potential
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

42. at four years of age - What are the social - fine motor - gross motor - and language developments?
Gluteus maximus; difficulty getting up from seated position and climbing chair
In the extracellular space for collagen cross linking; zinc
As a CO2 carrier with the carboxylase enzyme
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

43. What causes vertical diplopia? horizontal?
Spongiosis
TCAs and prazosin
Trochlear nerve (IV); abducens nerve (VI)
only up to bronchi

44. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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)
CGD; t cell dysfxn (diGeorge)

45. what vessel would a fracture to the neck of the of the humerus damage?
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
11 aa polypeptide; pain NT in CNS and PNS
Vancomycin
Anterior circumflex (and axillary nerve)

46. What is the immune deficinecy seen in ataxia telangactasia?
Rabies encephalitis from cave bats; rabies killed vaccines
Recurrent larygneal
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Ig A deficiency

47. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
P53 mutation; DCC is also required for adenoma to carcinoma
Well trained athletes and children
Chorda tympani branch

48. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Regular insulin (Not fast acting - regular better)
Acute gastric mucosal defects (superficial or full thickness)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

49. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Inactivates kallikrein which activates kininogen into bradykinin
Become beta pleated and then form neurofibrillary tangle!

50. What are three symptoms in s.typhi?
Strength of cell mediated immune response
Syringomelia
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Elevated GGT and macrocytosis