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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 are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
To pump calcium out in cardiac myocytes so that relaxation occurs
Pan colitis and right sided colitis (more than left sided and proctitis)
Chrom 8

2. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Superior larygeal; cricothyroid; recurrent laryngeal
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

3. which cells produce surfactant? which ones mediate gas exchange?
Dissolved in plasma and attached to Hgb
II; I (I more abundant)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
<1% - 55% - concentration dependent

4. what virus causes pharyngoconjuctival fever?
Folic acid treatment!
Hypo or hyper pigmentations; after tanning
Adeno
Closer to head; closer to diaphragm

5. What is medullary sponge kidney disease and how does it present? What does it lead to?
facultative intracellular
Turbulence
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)
Right heart failure

6. what nerve and artery course along the posterior aspect of the humerus?
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
Bile salt accumulation in urine
Radial nerve and deep brachial artery
C3 decreased after 5-10 days; sulfonamides

7. What is pickwickian syndrome? What are the lab findings?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Multiple miscarriages d/t hypercoaguability

8. Where does terminal peptide cleavage of collagen fibrils take place?
Spongiosis
HSV ( also in utero: chlymadia - neisseria - group B strep)
In the extracellular space
Increase in permeability of two ions with equal and opposite equilibrium potentials

9. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Pain reliever - reduces pain by locking substance P in the PNS
Sarcoid
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

10. what locations of UC increase the risk of Colon cancer?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
T test; chi squared
Pan colitis and right sided colitis (more than left sided and proctitis)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

11. What does C1 esterase do other than inhibiting complement pathway?
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
Inactivates kallikrein which activates kininogen into bradykinin
Octreotide
Chrom 8

12. How do you calculate atributable risk percent?
indomethacin
RR-1/RR
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

13. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
T test; chi squared
Cluster
Tissue redistribution (out of plasma) rather than metabolism
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

14. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

15. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Extrinsic def; instrinsic def; platelet def
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
RER; copper

16. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Leukotriene precursor and does neutrophil chemotaxis
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Turners`
Valproate

17. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Both sides
Relfex tachycardia; giving beta blockers
Sydenham chorea
Become beta pleated and then form neurofibrillary tangle!

18. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
HSV and VZV
Skin flushing and warmth; prostaglandins; give with aspirin

19. What is the precursor protein to beta amyloid and On what chromosome is it found?
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
APP on chrom 21 (this is why downs more susceptible)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
RR-1/RR

20. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
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)
E. coli; staphylococcus saprophyticus
differentiate
Hereditary angioedema; ACE inhibitors

21. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
differentiate
11 aa polypeptide; pain NT in CNS and PNS
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

22. what indicates the severity of a mitral regurg ? mitral stenosis?
Southern - western
S3 gallop; S2 to opening snap interval
Biphosphonate
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

23. which nucleus releases serotonin?
Around 70 (normal measured diastolic pressures); 9--
Paramyxo and influenza
Raphe
low in serum

24. other than mycobacterim wha other bacteria is acid fast?
Folic acid treatment!
Nocardia
Joints d/t increased purine production and thus uric acid production
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

25. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Fibrosis; macrophages
MAO inhibitors; wine and cheese
No; MRI
SVC and IVC; right below the aortic knob

26. What does prolonged PT indicated? aPTT? bleeding time?
Serum creatine kinase; reperfusion injury causes necrosis
Extrinsic def; instrinsic def; platelet def
Aromatase deficiency in child
Chlorpheniramine and diphenhydramine

27. What is the cause of rapid plasma decay of thiopental?
P53 mutation; AD
Tissue redistribution (out of plasma) rather than metabolism
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

28. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
In the extracellular space for collagen cross linking; zinc
Increased reticulocytes
Skin flushing and warmth; prostaglandins; give with aspirin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

29. What is the Na/Ca exchange used for?
Amiloride - spironolactone - triamterene
To pump calcium out in cardiac myocytes so that relaxation occurs
Around 70 (normal measured diastolic pressures); 9--
Barium enema

30. What are diastolic (lowest) pressures in aorta? LV?
In the extracellular space
Around 70 (normal measured diastolic pressures); 9--
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
Bile salt accumulation in urine

31. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
glycerol kinase
Joints d/t increased purine production and thus uric acid production
P53 mutation; AD

32. What are two common side effects of both acute and long acting nitrates? What causes them?
Tissue redistribution (out of plasma) rather than metabolism
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Headaches and facial flushing; vasodilation in meninges and skin
E6 and E7 of HPV knock off p53 and Rb suppressor genes

33. What is Tzanck smear used to detect?
Think Hb deformation diseases
Tibial
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
HSV and VZV

34. 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?
Underestimation of gestational age
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Neisseria induced small cell vasculitis (including hands and soles)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

35. How can renal blood flow be calculated from RPF?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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
Anterior circumflex (and axillary nerve)
RBF= PAH clearance/(1- hematocrit)

36. What is used to treat heparin toxicity?
Protamine sulfate
Think Hb deformation diseases
INTRApartum Abs (ampicillin/penicillin)
Hexokinase

37. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Susceptible; soluble (unable to be cultured in bile)
Gluteus medius and minimus; positive trendelenberg
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

38. other than proteinuria - What can cause foamy froathy urine?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Bile salt accumulation in urine
Prevents hepatic VLDL production
Env genes (for getting into target cells)

39. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Tzanck smear
Radial nerve damage
Vancomycin; histamine mediated

40. which staphylococci can do mannitol fermaentation?
Measles and M3 AML`
Drink plenty of fluids
S. aureus
Trochlear nerve (IV); abducens nerve (VI)

41. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
NF- KB; responsible for cytokine production
Folic acid treatment!

42. What are the two coagulase negative staphylococci? How do you distinguish them?
Tissue redistribution (out of plasma) rather than metabolism
Ketone body production by preventing fatty acids into the mitochondria
SVT; increases vagal tone; rectus abdominis
S. saprophyticus - and s. epidermidis; novobiocin

43. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Increased reticulocytes
Vascular endothelium; protease
C3 decreased after 5-10 days; sulfonamides
Joints d/t increased purine production and thus uric acid production

44. at four years of age - What are the social - fine motor - gross motor - and language developments?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Susceptible; soluble (unable to be cultured in bile)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vancomycin; histamine mediated

45. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Vascular endothelium; protease
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
chronic urticaria and allergic symptoms

46. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
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
Inhibits it
Trauma to stereociliated hair cells of the organ of corti

47. What is best to prevent GBS infection in a baby?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
INTRApartum Abs (ampicillin/penicillin)
Retinitis; mononucleosis
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

48. What is used to compare means? categorical outcomes?
Tissue redistribution (out of plasma) rather than metabolism
Ig A deficiency
T test; chi squared
Initiation - pointing; pincer grasp; walking; mama/dada

49. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
TSh (in testicular tumors can cause hyperthyroidism)
Extrinsic def; instrinsic def; platelet def

50. Which nerve lies in close proximity to the inferior thyroid artery?
Hypertension - edema - and proteinuria
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Recurrent larygneal
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration