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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Chlorpheniramine and diphenhydramine
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

2. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
hyponatremia (aldosterone activation equilibrates body volume)
Anterior circumflex (and axillary nerve)
Serum creatine kinase; reperfusion injury causes necrosis

3. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
gram positive organisms
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Ether and other organic solvents
No (unlike adenomyosis); yes

4. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
SVC and IVC; right below the aortic knob
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Primary

5. Metronidizaole does not cover...
Purkinje system; AV node
Medial part
High potassium conductance and some sodium conductance
gram positive organisms

6. 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
Prepatellar
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Around 70 (normal measured diastolic pressures); 9--

7. there are mucus secreting cells in the bronchioles...
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)
Prevent phagocytosis
only up to bronchi
11 aa polypeptide; pain NT in CNS and PNS

8. What is the neurologic manifestation of ADPKD?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
S3 gallop; S2 to opening snap interval
Protamine sulfate

9. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Decreases both
Squatting - sitting - lying supine - passive leg raising
S. saprophyticus - and s. epidermidis; novobiocin

10. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Radial nerve damage
AV node slowest - to allow time for diastole
women
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

11. What is intussusception? how does ischemia and necrosis occur?
Localized dermatologic pain that persists for more than one month after zoster eruption
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
NF- KB; responsible for cytokine production
Downs; regurgitant AV valves - ASDs

12. What does C1 esterase do other than inhibiting complement pathway?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Medullary
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Inactivates kallikrein which activates kininogen into bradykinin

13. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
RBC mass; epo levels (secondary has high)
Prevents hepatic VLDL production
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
P53 mutation; AD

14. What agonists reduce the gradient across the LV outflow tract?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Selective alpha 1 (increases SVR)
The time interval between S2 and OS- the shorter the interval - the more intense
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

15. what kind of drug is sertraline? What is a common side effect?
8 (myc protein) with 2 - 14 - 22 (iG chains)
liver specific
SSRI; erectile dysfunction
By vascular permeability and vasodilation

16. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Coagulation factors are made in the liver
Well trained athletes and children
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

17. 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?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Common peroneal; bony fractures and compression; sciatic
The term used to describe decreased drug responsiveness with repeated administration

18. What is the most common location of colonization of all s. aureus types?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Anterior nares
Adductor
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

19. why is glucagon used in beta blocker toxicitiy?
Syncope - angina - dyspnea (SAD)
RR-1/RR
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
LT (LTD4 - E4 - C4) - and Ach

20. what drugs causes the red man syndrome? how does it occur?
Superior larygeal; cricothyroid; recurrent laryngeal
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Vancomycin; histamine mediated
Headaches and facial flushing; vasodilation in meninges and skin

21. What type of mutation does aflatoxin cause? what cancer does this increase for?
Regular insulin (Not fast acting - regular better)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Anterior circumflex (and axillary nerve)
G to T in p53; HCC

22. in the LV and aorta - What are the pressures?
No and yes
Pulmonic and systemic!
Hyperkalemia; potassium sparing diuretics - potassium supplements
Normally close to systolic

23. What is a cell surface marker seen in liver angiosarcoma?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Regular insulin (Not fast acting - regular better)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

24. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
By vascular permeability and vasodilation
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

25. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
CGD; t cell dysfxn (diGeorge)
Medial part
Nonsense; mRNA processing
When it invades the bm; carcinoma in situ

26. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increase; decreased
Sudden loss of muscle tone without loss of consciousness; narcolepsy

27. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
NF- KB; responsible for cytokine production
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

28. What does nitroprusside do to afterload? preload?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
women
Decreases both
Chlorpheniramine and diphenhydramine

29. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
8 (myc protein) with 2 - 14 - 22 (iG chains)
Strength of cell mediated immune response
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

30. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
GI tract; mood!
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
INTRApartum Abs (ampicillin/penicillin)
ANCA because of lack of Ig and C3 deposits on IF

31. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
women
Sydenham chorea
In ER of bile canaliculi
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

32. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Common peroneal; bony fractures and compression; sciatic
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

33. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Apocrine; eccrine

34. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Inactivates kallikrein which activates kininogen into bradykinin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
No; MRI
ANCA because of lack of Ig and C3 deposits on IF

35. How do you calculate RPF from urine PAH?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Ketone body production by preventing fatty acids into the mitochondria
(urine PAH x urine flow rate)/plasma PAH
II; I (I more abundant)

36. What is the most common neurologic complication of VZV reactivation?
Rabies encephalitis from cave bats; rabies killed vaccines
11 aa polypeptide; pain NT in CNS and PNS
Vagus (auricular branch); vasovagal syncope!
Localized dermatologic pain that persists for more than one month after zoster eruption

37. What is the mc malignancy in asbestosis?
Lateral; RV; RA; LV
Bronchogenic carcinoma
Anterior nares
E6 and E7 of HPV knock off p53 and Rb suppressor genes

38. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
NF- KB; responsible for cytokine production
P53 mutation; AD
SS +rNA
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

39. What are examples of action that decrease venous return to the heart?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Standing suddenly from supine position; valsalva maneuver
11
No; MRI

40. what happens with LDL receptor density in statin therapy?
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
Increases
Chorda tympani branch
Diabetic microangiopathy

41. what clinical findings help distinguish small cell carcinoma?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Barium enema
Spongiosis

42. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Little effect on cell and no change
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Vancomycin

43. In what form are mitochondrial DNA? What do they transcribe?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Circular - outside nucleus; transport proteins - rRNA - tRNA
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Highly negative resting potential

44. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Hypothyroidism
Barium enema
To pump calcium out in cardiac myocytes so that relaxation occurs

45. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Medial part
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

46. prostaglandin synthesis keeps...
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
PDA open
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Intussusception

47. How do bradykinin - C3a and C5a cause edema?
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
Hexokinase
The term used to describe decreased drug responsiveness with repeated administration
By vascular permeability and vasodilation

48. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Class I
By vascular permeability and vasodilation
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

49. What is the preferred treatment for DKA?
Increases cytokine production
Regular insulin (Not fast acting - regular better)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
SS +rNA

50. What are the long term consequences of hydrocephalus?
Terminal bronchioles; small bronchi
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

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USMLE Prep 2

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