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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 the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Medial part
Vascular endothelium; protease
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Classical conditioning

2. ___________ is liver specific
Well
glycerol kinase
Fibronectin - laminin - collagen
Chlorpheniramine and diphenhydramine

3. How can renal blood flow be calculated from RPF?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Tissue redistribution (out of plasma) rather than metabolism
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
RBF= PAH clearance/(1- hematocrit)

4. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Hypertension - edema - and proteinuria
Another type of aldosterone antagonist (like spironolactone)
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
women

5. the rate of blood flow of which two circulations must equal each other at all times?
No
Ig A deficiency
Pulmonic and systemic!
Increases bronchial and vascular smooth muscle reactivity to catecholamines

6. What agonists reduce the gradient across the LV outflow tract?
No (unlike adenomyosis); yes
Selective alpha 1 (increases SVR)
Vagus (auricular branch); vasovagal syncope!
Prepatellar

7. what receptors do first generation anti histamines block?
No and yes
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Kallmans
Medial circumflex artery; avascular necrosis

8. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SVT; increases vagal tone; rectus abdominis
S3 gallop; S2 to opening snap interval
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

9. What is the difference between additive and synergistic?
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
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
SVC and IVC; right below the aortic knob
8 (myc protein) with 2 - 14 - 22 (iG chains)

10. What are fenfluramine - phentermine?
Appetite suppressants
Closer to head; closer to diaphragm
E. coli
Hexokinase

11. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Bile soluble which means they are bile sensitive
Anterior circumflex (and axillary nerve)
Inactivates kallikrein which activates kininogen into bradykinin

12. what protects the resting heart from arrhythmias?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anterior circumflex (and axillary nerve)
Highly negative resting potential
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

13. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

14. in the LV and aorta - What are the pressures?
glycerol kinase
No and yes
Normally close to systolic
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

15. What is diagnostic (and possible therapeutic for intussusception)?
SVC and IVC; right below the aortic knob
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Barium enema
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

16. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Phencyclidine (PCP)
Hereditary angioedema; ACE inhibitors
Medullary
Raphe

17. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
manifestations - congenital (stretching of periventricular pyrimadal fibers)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

18. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Pulmonary hypertension
Echinococcus granulosus; anaphylaxis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Syringomelia

19. What does extended consumption of appetite suppressants lead to?
Myasthenia gravis
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)
Pulmonary hypertension
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

20. What is an abortive viral infection?
S3 gallop; S2 to opening snap interval
liver specific
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Little effect on cell and no change

21. 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
Prepatellar
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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)

22. What are the skin presentation in sarcoid?
HSV and VZV
Varying; erythema nodosum is common
Amiadarone
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

23. What does TGF beta do? What produces it?
Purkinje system; AV node
Adductor
Proteasome inhibitor; treatment for MM and waldenstroms
Fibrosis; macrophages

24. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
E. coli; staphylococcus saprophyticus
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

25. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Classical conditioning
46 - 4N; 23 2N
Bile salt accumulation in urine

26. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Adeno
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
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

27. What is a keloid?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Spongiosis
Normal; low
Excessive collagen formation during tissue repair in susceptible individuals

28. is Rifampin ever used as monotherapY? why either way?
Bile soluble which means they are bile sensitive
Anti centromere; anti DNA topoisomerase
Mean greater than median greater than mode
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

29. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
hyponatremia (aldosterone activation equilibrates body volume)
Dihydropyridine sensitive Ca channels (L type)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

30. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Susceptible; soluble (unable to be cultured in bile)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Chrom 8

31. What is omalizumab and What is it used for?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Large stroke volumes with ventricular contraction; aortic regurg
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

32. what immune deficiency causes recurrent neisseria infections?
LT (LTD4 - E4 - C4) - and Ach
MAC complex (C5b - C9 complement deficiency)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

33. What are the first generation anti histamines?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
The term used to describe decreased drug responsiveness with repeated administration
Chlorpheniramine and diphenhydramine

34. what organ would an activating mutation in PRPP synthetase effect?
chronic urticaria and allergic symptoms
Joints d/t increased purine production and thus uric acid production
Purkinje system; AV node
Increase lymphatic drainage!

35. In What type of nephritis would you see high serum eos count?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Drug induced interstitial nephritis
Phencyclidine (PCP)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

36. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Paramyxo and influenza
Insulin like growth factor 1 (just another name)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

37. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Because gamma chains replace beta chains and then gamma chain formation wanes
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

38. why are pregnant predisposed to cholelithiasis?
Medial circumflex artery; avascular necrosis
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
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

39. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Class I
Insulin like growth factor 1 (just another name)
CGD; t cell dysfxn (diGeorge)

40. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Fat - fertile - forty - female
Lateral; RV; RA; LV

41. What is epispadias caused by?
Faulty positioning of the genital tubercle
E. coli
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Skin flushing and warmth; prostaglandins; give with aspirin

42. what virus causes pharyngoconjuctival fever?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Adeno

43. How do you calculate RPF from urine PAH?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Fibronectin - laminin - collagen
(urine PAH x urine flow rate)/plasma PAH
200-500

44. How do you calculate atributable risk percent?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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
11
RR-1/RR

45. within the right atrium - What is the maximum pressure? left atrium?
Vagus nerve stimulation
8; 12
46 - 4N; 23 2N
GI tract; mood!

46. What does protein M do in Group A strep<
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Prevent phagocytosis
In the extracellular space for collagen cross linking; zinc
Increased reticulocytes

47. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
LT (LTD4 - E4 - C4) - and Ach
Apocrine; eccrine
Sydenham chorea

48. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Increases cytokine production
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Prepatellar

49. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Drink plenty of fluids
Syncope - angina - dyspnea (SAD)

50. neisseria are...
E6 and E7 of HPV knock off p53 and Rb suppressor genes
facultative intracellular
SSRI; erectile dysfunction
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2