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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. Where does conjugation of bilirubin take place?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Right heart failure
In ER of bile canaliculi
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

2. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Vagus (auricular branch); vasovagal syncope!
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
MAO inhibitors; wine and cheese

3. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Sydenham chorea
RBC mass; epo levels (secondary has high)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Another type of aldosterone antagonist (like spironolactone)

4. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
facultative intracellular
Right heart failure
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Medullary

5. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Reticulocytes
Tzanck smear

6. What is tachyphylaxis?
Folic acid treatment!
The term used to describe decreased drug responsiveness with repeated administration
Dihydropyridine sensitive Ca channels (L type)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

7. why does hypothyroidism cause increased CPK levels?
Pain reliever - reduces pain by locking substance P in the PNS
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Appetite suppressants
Vancomycin; histamine mediated

8. What is the best indicator for the severity of mitral stenosis?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Nocardia
The time interval between S2 and OS- the shorter the interval - the more intense
Extrinsic def; instrinsic def; platelet def

9. What is the precursor protein to beta amyloid and On what chromosome is it found?
Close but purkinje system to ensure contraction in a bottom up fashion
APP on chrom 21 (this is why downs more susceptible)
Brief psychotic disorder; schizophreniform; schizophrenia
Aromatase deficiency in child

10. how long is substance P? What does it do?
HSV and VZV
Chorda tympani branch
46 - 4N; 23 2N
11 aa polypeptide; pain NT in CNS and PNS

11. which staphylococci can do mannitol fermaentation?
Increase by 50% in urine osmolality
INTRApartum Abs (ampicillin/penicillin)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
S. aureus

12. Metronidizaole does not cover...
gram positive organisms
C3 decreased after 5-10 days; sulfonamides
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Adductor

13. name three pathological states that present with large tongues.
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Octreotide
Bile salt accumulation in urine
Congenital hypothyroidism - downs - amyloidosis - acromegaly

14. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
gram positive organisms
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
II; I (I more abundant)

15. there are mucus secreting cells in the bronchioles...
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Acute interstitial nephritis
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
only up to bronchi

16. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
ANCA because of lack of Ig and C3 deposits on IF
Turners`
Integration of viral DNA into genome of host hepatocytes

17. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
Kallmans
Pain reliever - reduces pain by locking substance P in the PNS
As a CO2 carrier with the carboxylase enzyme

18. is Rifampin ever used as monotherapY? why either way?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Mean greater than median greater than mode
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
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase

19. What triggers the neoplastic changes that are associated with HBV infecton?
Hypertension - edema - and proteinuria
11 aa polypeptide; pain NT in CNS and PNS
No and yes
Integration of viral DNA into genome of host hepatocytes

20. What is the preferred treatment for DKA?
<1% - 55% - concentration dependent
Underestimation of gestational age
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Regular insulin (Not fast acting - regular better)

21. which nucleus releases serotonin?
...
SVC and IVC; right below the aortic knob
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Raphe

22. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Tzanck smear
transcription activation/suppression
Classical conditioning

23. What is the cause of fixed splitting of S2? why?
Vancomycin
4 - 4 - 9
facultative intracellular
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

24. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
OCPs - multiparity - breast feeding
Fat - fertile - forty - female
E. coli; staphylococcus saprophyticus

25. What is the diagnosis in delayed puberty plus anosmia?
Chrom 8
Kallmans
TSh (in testicular tumors can cause hyperthyroidism)
Rabies encephalitis from cave bats; rabies killed vaccines

26. how much percent of sodium is excreted? urea? glucose?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
On cardiac tissue and renal juxtaglomerular cells
DIC; TTP- HUS dont bleed that much
<1% - 55% - concentration dependent

27. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
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
Radial nerve and deep brachial artery
Hypo or hyper pigmentations; after tanning

28. What effects does cortisol have on catecholamines?
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
liver specific
Elevated GGT and macrocytosis
When it invades the bm; carcinoma in situ

29. 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
Large stroke volumes with ventricular contraction; aortic regurg
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Pain reliever - reduces pain by locking substance P in the PNS

30. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Standing suddenly from supine position; valsalva maneuver
Relfex tachycardia; giving beta blockers
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Hypothyroidism

31. What is a keloid?
Underestimation of gestational age
Intussusception
200-500
Excessive collagen formation during tissue repair in susceptible individuals

32. What is diagnostic (and possible therapeutic for intussusception)?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Barium enema
Sarcoid
only up to bronchi

33. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Rabies encephalitis from cave bats; rabies killed vaccines
Regular insulin (Not fast acting - regular better)
S. saprophyticus - and s. epidermidis; novobiocin

34. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
RER; RER
Clindamycin; covers anaerobic oral flora and aerobic bacteria
glycerol kinase

35. How is dobutamine better than dopamine?
No (unlike adenomyosis); yes
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Paramyxo and influenza
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

36. sporadic colon cancer tend to arise From what type of polyps?
S. aureus
Single adenomatous ones
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

37. h1 receptor anatagonists are not effective in treatment of asthma only for...
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
OCPs - multiparity - breast feeding
chronic urticaria and allergic symptoms

38. within the right atrium - What is the maximum pressure? left atrium?
Tissue redistribution (out of plasma) rather than metabolism
8; 12
Become beta pleated and then form neurofibrillary tangle!
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

39. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Phencyclidine (PCP)
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
<1% - 55% - concentration dependent

40. Acyl coA synthetase is not...
liver specific
Turners`
Duration and extent of disease
INTRApartum Abs (ampicillin/penicillin)

41. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Ether and other organic solvents
INTRApartum Abs (ampicillin/penicillin)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Sickle cell; G6PD

42. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Bronchogenic carcinoma
By vascular permeability and vasodilation
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

43. What is pickwickian syndrome? What are the lab findings?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Hypothyroidism

44. What causes wrist drop?
Diabetic microangiopathy
Vascular endothelium; protease
Multiple miscarriages d/t hypercoaguability
Radial nerve damage

45. Where is the base of the heart? apex?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Closer to head; closer to diaphragm
Proteasome inhibitor; treatment for MM and waldenstroms
8; 12

46. other than increasing HDL levels - what else does niacin do?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Prevents hepatic VLDL production
Ceftriaxone; azithromycin

47. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Trochlear nerve (IV); abducens nerve (VI)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Tibial

48. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hyperkalemia; potassium sparing diuretics - potassium supplements
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

49. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Biphosphonate
hyponatremia (aldosterone activation equilibrates body volume)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

50. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Hypo or hyper pigmentations; after tanning
Little effect on cell and no change
Close but purkinje system to ensure contraction in a bottom up fashion