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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 potassium sparing diuretics?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Excessive collagen formation during tissue repair in susceptible individuals
RER; RER
Amiloride - spironolactone - triamterene

2. When is an S4 sound normal?
Well trained athletes and children
Vagus (auricular branch); vasovagal syncope!
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

3. What is used to compare means? categorical outcomes?
T test; chi squared
Prevents hepatic VLDL production
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Hexokinase

4. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Paramyxo and influenza
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Increase; decreased

5. What type of endocarditis is cytoscopy induced?
Radial nerve damage
Enterococci (e. faecalis)- found on genitalia area
Tzanck smear
Acute gastric mucosal defects (superficial or full thickness)

6. what bursa is affected when on knees like a maid/gardner?
Large stroke volumes with ventricular contraction; aortic regurg
Decreases both
Prepatellar
Biphosphonate

7. What is tachyphylaxis?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Tibial
The term used to describe decreased drug responsiveness with repeated administration

8. What is the difference between paranoid personality disorder and delusional disorder?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Neisseria induced small cell vasculitis (including hands and soles)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
CGD; t cell dysfxn (diGeorge)

9. What is the most important prognostic indicator in patients with malignant melanoma?
Radial nerve damage
Measure of depth invasion (vertical!)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
TSh (in testicular tumors can cause hyperthyroidism)

10. What test would be best to determine if a gene is being transcribed? translated?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Southern - western
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

11. What do you treat s. epidermidis with?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Vancomycin

12. Which is faster atrial muscle or ventricular muscle?
Atrial
RER; RER
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
Bile salt accumulation in urine

13. How do bradykinin - C3a and C5a cause edema?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
By vascular permeability and vasodilation
facultative intracellular
Bronchogenic carcinoma

14. what nerve and artery course along the posterior aspect of the humerus?
Turners`
Minimal change disease
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Radial nerve and deep brachial artery

15. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Anterior circumflex (and axillary nerve)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Syringomelia

16. within the right ventricle - What are maximum pressures? the pulm arter?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
ATP binding (resets the myosin head to contract again for next binding)
Drug induced interstitial nephritis
25; 25

17. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
T test; chi squared
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
LT (LTD4 - E4 - C4) - and Ach
C3 decreased after 5-10 days; sulfonamides

18. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Amiadarone
IgE
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

19. Where is conduction in heart fastest? slowest?
low in serum
No; yes
Close but purkinje system to ensure contraction in a bottom up fashion
Purkinje system; AV node

20. What is the mc malignancy in asbestosis?
Reticulocytes
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Bronchogenic carcinoma

21. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Skin flushing and warmth; prostaglandins; give with aspirin
Increase by 50% in urine osmolality
Amiadarone

22. at three years of age What are social - fine motor - gross motor and language developments?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
In ER of bile canaliculi
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
RBF= PAH clearance/(1- hematocrit)

23. after a thrombus extraction - what serum enzyme shoots up and why?
Myasthenia gravis
Radial nerve damage
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Serum creatine kinase; reperfusion injury causes necrosis

24. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
RBC mass; epo levels (secondary has high)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

25. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Think Hb deformation diseases
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Apocrine; eccrine

26. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
Purkinje system; AV node
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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

27. What is suggestive of complete central DI?
hyponatremia (aldosterone activation equilibrates body volume)
Increase by 50% in urine osmolality
Strength of cell mediated immune response
Tissue redistribution (out of plasma) rather than metabolism

28. how does achalasia present? What does barium swallow show on dilated esophagus?
Gluteus medius and minimus; positive trendelenberg
(urine PAH x urine flow rate)/plasma PAH
INTRApartum Abs (ampicillin/penicillin)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

29. What are the three dopaminergic systems and What are they responsible for? disease?
Normally close to systolic
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
liver specific

30. hypertonicity and hyperreflexity are ________________ of hydrocephalus
No
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
manifestations - congenital (stretching of periventricular pyrimadal fibers)

31. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Normal; low
S. saprophyticus - and s. epidermidis; novobiocin

32. What are the two coagulase negative staphylococci? How do you distinguish them?
4 - 4 - 9
Skin flushing and warmth; prostaglandins; give with aspirin
S. saprophyticus - and s. epidermidis; novobiocin
ANCA because of lack of Ig and C3 deposits on IF

33. what happens with LDL receptor density in statin therapy?
Increases
Sydenham chorea
Relfex tachycardia; giving beta blockers
Cluster

34. What does protein M do in Group A strep<
Coagulation factors are made in the liver
Prevent phagocytosis
INTRApartum Abs (ampicillin/penicillin)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

35. which RPGN is also called pauci immune GN? why?
...
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Ketone body production by preventing fatty acids into the mitochondria
ANCA because of lack of Ig and C3 deposits on IF

36. What is a clara cell?
T test; chi squared
S. aureus
Syncope - angina - dyspnea (SAD)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

37. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Syncope - angina - dyspnea (SAD)
Dihydropyridine sensitive Ca channels (L type)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

38. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
To pump calcium out in cardiac myocytes so that relaxation occurs
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

39. nucleotide deletions do not cause missense mutations - they cause...
Inhibits it
APP on chrom 21 (this is why downs more susceptible)
frameshift mutations (missense is substitution)
Little effect on cell and no change

40. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Sydenham chorea
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
P53 mutation; DCC is also required for adenoma to carcinoma

41. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Prevents hepatic VLDL production
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Bile salt accumulation in urine

42. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Rabies encephalitis from cave bats; rabies killed vaccines
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

43. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
25; 25
Not lined by epithelium
Nonsense; mRNA processing

44. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Rabies encephalitis from cave bats; rabies killed vaccines
Reiter syndrome; B27
Fibronectin - laminin - collagen
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

45. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
PDA open
frameshift mutations (missense is substitution)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
V fib; v. failure

46. What is the neurologic manifestation of ADPKD?
Adeno
SVC and IVC; right below the aortic knob
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Initiation - pointing; pincer grasp; walking; mama/dada

47. What is damaged in early syringomelia? later?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
<1% - 55% - concentration dependent
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

48. what chromosome is c - myc found on?
Chrom 8
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Sydenham chorea
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)

49. What is the most common neurologic complication of VZV reactivation?
Because of vasodiation to skeletal muscles
Localized dermatologic pain that persists for more than one month after zoster eruption
Vascular endothelium; protease
Pulmonary hypertension

50. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
women
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Excessive collagen formation during tissue repair in susceptible individuals
Varying; erythema nodosum is common