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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 preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
TCAs and prazosin
CMV - HSV 1 - Candida
V fib; v. failure

2. what drugs causes the red man syndrome? how does it occur?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Medial part
Enterococci (e. faecalis)- found on genitalia area
Vancomycin; histamine mediated

3. what chromosome is c - myc found on?
Because gamma chains replace beta chains and then gamma chain formation wanes
Chrom 8
transcription activation/suppression
As a CO2 carrier with the carboxylase enzyme

4. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Measure of depth invasion (vertical!)
Trauma to stereociliated hair cells of the organ of corti
Dihydropyridine sensitive Ca channels (L type)

5. in overweight individuals What is thought to contribute to insulin resistance?
Hexokinase
Serum FFA and serum triglyceride levels
C3 decreased after 5-10 days; sulfonamides
PDA open

6. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
transcription activation/suppression
Vagus (auricular branch); vasovagal syncope!

7. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Fibronectin - laminin - collagen
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
only up to bronchi
Valproate

8. name three pathological states that present with large tongues.
Single adenomatous ones
Congenital hypothyroidism - downs - amyloidosis - acromegaly
<1% - 55% - concentration dependent
No; yes

9. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Intussusception
C3 decreased after 5-10 days; sulfonamides
MAO inhibitors; wine and cheese

10. What is hypospadias caused by?
Abnormal closing of the urethral folds
Dissolved in plasma and attached to Hgb
ZDV or AZT
Drink plenty of fluids

11. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Both sides
Single adenomatous ones

12. how does neisseria cause a petechial rash?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Neisseria induced small cell vasculitis (including hands and soles)
In the extracellular space for collagen cross linking; zinc
Increased reticulocytes

13. What is a primary HSV 1 infection like?
Fibronectin - laminin - collagen
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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

14. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Raphe
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

15. Where does 90% of serotonin lie? What is this NT responsible?
Coagulation factors are made in the liver
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
GI tract; mood!
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

16. Where is conduction in heart fastest? slowest?
V fib; v. failure
Purkinje system; AV node
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

17. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Prevents hepatic VLDL production
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
In the extracellular space
Phencyclidine (PCP)

18. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Decreases both
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
S. aureus

19. What is cataplexy and When is it seen?
MAO inhibitors; wine and cheese
hyponatremia (aldosterone activation equilibrates body volume)
Amiloride - spironolactone - triamterene
Sudden loss of muscle tone without loss of consciousness; narcolepsy

20. What is the triad seen in pre eclampsia?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Hypertension - edema - and proteinuria
S. aureus

21. What are the long term consequences of hydrocephalus?
hyponatremia (aldosterone activation equilibrates body volume)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
OCPs - multiparity - breast feeding
facultative intracellular

22. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
gram positive organisms
Multiple miscarriages d/t hypercoaguability
Vagus nerve stimulation
Syringomelia

23. SIADH patients have normal blood volume but...
Acute interstitial nephritis
SVC and IVC; right below the aortic knob
hyponatremia (aldosterone activation equilibrates body volume)
indomethacin

24. When is an S4 sound normal?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Octreotide
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Well trained athletes and children

25. at three years of age What are social - fine motor - gross motor and language developments?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Large stroke volumes with ventricular contraction; aortic regurg
CMV - HSV 1 - Candida
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

26. What is used to compare means? categorical outcomes?
T test; chi squared
Dihydropyridine sensitive Ca channels (L type)
low in serum
Increased reticulocytes

27. What is subacute sclerosisng encephalitis caused by?
11 aa polypeptide; pain NT in CNS and PNS
OCPs - multiparity - breast feeding
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
Inhaled animal dander allergens

28. why does hypothyroidism cause increased CPK levels?
Extrinsic def; instrinsic def; platelet def
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
HSV ( also in utero: chlymadia - neisseria - group B strep)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

29. What is congestive hepatomegaly specific for?
Medial circumflex artery; avascular necrosis
Right heart failure
SVC and IVC; right below the aortic knob
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

30. What are the potassium sparing diuretics?
V fib; v. failure
RER; RER
Demargination of neutrophils from the vessel walls
Amiloride - spironolactone - triamterene

31. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Prostate tumor and increased osteoclast activity
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

32. what receptors do first generation anti histamines block?
Become beta pleated and then form neurofibrillary tangle!
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
I is more benign and can present later in adulthood
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

33. what enzyme converts procarcinogens into carcinogens?
Localized dermatologic pain that persists for more than one month after zoster eruption
liver specific
P450 mitochondrial monooxygenase
SSRI

34. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vascular endothelium; protease
Increase by 50% in urine osmolality
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

35. what defines hypoxemia?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
SaO2 <92%
<1% - 55% - concentration dependent
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

36. what kind of drug is sertraline? What is a common side effect?
Terminal bronchioles; small bronchi
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Chlorpheniramine and diphenhydramine
SSRI; erectile dysfunction

37. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
46 - 4N; 23 2N
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
liver specific
Hydrogen bonds dictate alpha or beta structure

38. which nerve provides innervation for plantar flexion and inversion?
Tibial
Demargination of neutrophils from the vessel walls
As a CO2 carrier with the carboxylase enzyme
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

39. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
No; yes
8 (myc protein) with 2 - 14 - 22 (iG chains)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

40. how much percent of sodium is excreted? urea? glucose?
11
P450 mitochondrial monooxygenase
Sickle cell; G6PD
<1% - 55% - concentration dependent

41. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Fat - fertile - forty - female
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
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)
High potassium conductance and some sodium conductance

42. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Because of the low output from heart failure - they will have increased aldosterone levels
Rabies encephalitis from cave bats; rabies killed vaccines

43. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Think Hb deformation diseases
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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)

44. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
SS +rNA
Chorda tympani branch
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

45. metabolism of 1 gram of protein produces How many calories? carb? fat?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Neisseria induced small cell vasculitis (including hands and soles)
Ketone body production by preventing fatty acids into the mitochondria
4 - 4 - 9

46. IL4 is used for isotypye switching to what?
MAO inhibitors; wine and cheese
The term used to describe decreased drug responsiveness with repeated administration
Medial part
IgE

47. What actions increase venous return?
When it invades the bm; carcinoma in situ
Chorda tympani branch
Close but purkinje system to ensure contraction in a bottom up fashion
Squatting - sitting - lying supine - passive leg raising

48. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Thymic tumor
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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

49. What are two common side effects of both acute and long acting nitrates? What causes them?
Medial circumflex artery; avascular necrosis
When it invades the bm; carcinoma in situ
Headaches and facial flushing; vasodilation in meninges and skin
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

50. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Gluteus maximus; difficulty getting up from seated position and climbing chair
Phencyclidine (PCP)