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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 most common cause of hydatid cysts in humans? What does spilling of cysts cause?
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
Echinococcus granulosus; anaphylaxis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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

2. What is the cause of rapid plasma decay of thiopental?
No; MRI
Tissue redistribution (out of plasma) rather than metabolism
Vancomycin
200-500

3. What type of vision is myopia? In What type of patients does it improve?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
P53 mutation; DCC is also required for adenoma to carcinoma

4. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
SSRI
Turners`
low in serum

5. the rate of blood flow of which two circulations must equal each other at all times?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Hypertension - edema - and proteinuria
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Pulmonic and systemic!

6. What are two common side effects of both acute and long acting nitrates? What causes them?
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
Chlorpheniramine and diphenhydramine
differentiate
Headaches and facial flushing; vasodilation in meninges and skin

7. What does Rb protein do? what chrom is it on?
Proteasome inhibitor; treatment for MM and waldenstroms
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
SaO2 <92%
Atrial

8. 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?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
frameshift mutations (missense is substitution)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
ZDV or AZT

9. which virus inactivates both Rb and p53?
Little effect on cell and no change
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

10. what dissolves the lipid bilayer of a viral envelope?
Tibial
Ether and other organic solvents
25; 25
Extrinsic def; instrinsic def; platelet def

11. 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
Not lined by epithelium
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
P450 mitochondrial monooxygenase

12. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Proteasome inhibitor; treatment for MM and waldenstroms
Pulmonary hypertension
Medial part

13. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
I is more benign and can present later in adulthood
NF- KB; responsible for cytokine production
Tzanck smear
Because of vasodiation to skeletal muscles

14. biotin is used By what in tissues responsible for gluconeogenesis
Close but purkinje system to ensure contraction in a bottom up fashion
As a CO2 carrier with the carboxylase enzyme
Protamine sulfate
RBC mass; epo levels (secondary has high)

15. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Class I
Sickle cell; G6PD
Prevents hepatic VLDL production

16. what chromosome is c - myc found on?
Chrom 8
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
Acute interstitial nephritis
Atrial

17. What is suggestive of complete central DI?
Pan colitis and right sided colitis (more than left sided and proctitis)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increase by 50% in urine osmolality
Large stroke volumes with ventricular contraction; aortic regurg

18. What does anti phospholipid syndrome in SLE patients predispose them to?
Ether and other organic solvents
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Multiple miscarriages d/t hypercoaguability
ZDV or AZT

19. What does prolonged PT indicated? aPTT? bleeding time?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Extrinsic def; instrinsic def; platelet def

20. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Ceftriaxone; azithromycin
Vagus (auricular branch); vasovagal syncope!
Hexokinase
Joints d/t increased purine production and thus uric acid production

21. When is acid phosphatase elevated (Name two times)?
The term used to describe decreased drug responsiveness with repeated administration
Prostate tumor and increased osteoclast activity
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Radial nerve damage

22. How do you treat gonococcal infection? chlymadia?
Dihydropyridine sensitive Ca channels (L type)
Ceftriaxone; azithromycin
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Leukotriene precursor and does neutrophil chemotaxis

23. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Nonsense; mRNA processing
Phencyclidine (PCP)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

24. What is capacitance inversely proportional to?
Rabies encephalitis from cave bats; rabies killed vaccines
GI malignancies and Insulin resistance (acromegal for ex)
Elastance
Cluster

25. Where does complement bind on the Fc region of Ig chains?
Elevated GGT and macrocytosis
No
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

26. What is the fibrinogen level in patient with TTP- HUS? DIC?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hereditary angioedema; ACE inhibitors
Normal; low
Fat - fertile - forty - female

27. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
S3 gallop; S2 to opening snap interval
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
Retinitis; mononucleosis

28. What is a cord factor and Which bugs have it? How do they appear on culture?
Insulin like growth factor 1 (just another name)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
INTRApartum Abs (ampicillin/penicillin)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

29. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Duration and extent of disease
Well
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Lateral; RV; RA; LV

30. What is the mcc of elevated AFP leves in pregnancy>
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
RER; copper
gram positive organisms
Underestimation of gestational age

31. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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
ATP binding (resets the myosin head to contract again for next binding)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

32. carnitine deficiency impairs production of What and how?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Ketone body production by preventing fatty acids into the mitochondria
Faulty positioning of the genital tubercle
Highly negative resting potential

33. What agonists reduce the gradient across the LV outflow tract?
Skin flushing and warmth; prostaglandins; give with aspirin
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
Selective alpha 1 (increases SVR)
Insulin like growth factor 1 (just another name)

34. what induces bronchial squamous metaplasia?
Smoking
Underestimation of gestational age
Serum creatine kinase; reperfusion injury causes necrosis
By vascular permeability and vasodilation

35. What is the neurologic manifestation of ADPKD?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Closer to head; closer to diaphragm
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Nocardia

36. What are two indicators of chronic alcohol consumption?
Closer to head; closer to diaphragm
Hexokinase
Another type of aldosterone antagonist (like spironolactone)
Elevated GGT and macrocytosis

37. What is the most common initital symptom of ADPKD? what else?
Anterior circumflex (and axillary nerve)
TCAs and prazosin
Become beta pleated and then form neurofibrillary tangle!
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

38. What are the acute effects of corticosteroids on the CBC?
Decreases both
Little effect on cell and no change
II; I (I more abundant)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

39. in the LV and aorta - What are the pressures?
Recurrent larygneal
Hereditary angioedema; ACE inhibitors
Normally close to systolic
Inhibits it

40. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
Env genes (for getting into target cells)
Standing suddenly from supine position; valsalva maneuver
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

41. which two virus families have hemagluttinin on their surface?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Lateral; RV; RA; LV
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Paramyxo and influenza

42. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Amiadarone
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)
Measure of depth invasion (vertical!)

43. What does L/S stand for in fetal lung maturity? When does maturity occur?
facultative intracellular
Extrinsic def; instrinsic def; platelet def
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

44. what protein is increased in Crohns disease? What does it do?
In ER of bile canaliculi
Tzanck smear
NF- KB; responsible for cytokine production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

45. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
4 - 4 - 9
Phencyclidine (PCP)
Anti centromere; anti DNA topoisomerase

46. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Both sides
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Increased reticulocytes

47. In what form are mitochondrial DNA? What do they transcribe?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Diabetic microangiopathy
Circular - outside nucleus; transport proteins - rRNA - tRNA
Bronchial dilation (bronchiectasis)

48. how does eos release MBP to kill protozoa etc?
differentiate
ZDV or AZT
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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

49. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Serum FFA and serum triglyceride levels
Turners`
Prepatellar

50. What is best to prevent GBS infection in a baby?
Both sides
Folic acid treatment!
INTRApartum Abs (ampicillin/penicillin)
In the extracellular space