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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 it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
P53 mutation; DCC is also required for adenoma to carcinoma
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

2. what drug is useful for secretory diarrhea?
Smoking
Aromatase deficiency in child
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Octreotide

3. metabolism of 1 gram of protein produces How many calories? carb? fat?
Enterococci (e. faecalis)- found on genitalia area
Appetite suppressants
4 - 4 - 9
Ether and other organic solvents

4. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Covalent (between two cysteines)- allows protein to withstand denaturation
Inactivates kallikrein which activates kininogen into bradykinin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

5. neisseria are...
Thymic tumor
facultative intracellular
Anti cholinergic effects of pupil dilation and lack of accomodation
Smoking

6. 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?
Hypothyroidism
Fibrosis; macrophages
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Apocrine; eccrine

7. What is the triad seen in pre eclampsia?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Hypertension - edema - and proteinuria
frameshift mutations (missense is substitution)
4 - 4 - 9

8. what has the greatest effect on prognosis when treating c. diptheriae?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
HSV ( also in utero: chlymadia - neisseria - group B strep)
FGF and VEGF

9. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Excessive collagen formation during tissue repair in susceptible individuals
S3 gallop; S2 to opening snap interval
facultative intracellular

10. What is the mutation type in thalassemias? what process is defective because of this?
Folic acid treatment!
Hypothyroidism
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Nonsense; mRNA processing

11. What is the mc malignancy in asbestosis?
Selective alpha 1 (increases SVR)
Hexokinase
Common peroneal; bony fractures and compression; sciatic
Bronchogenic carcinoma

12. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
IgE
LT (LTD4 - E4 - C4) - and Ach
DIC; TTP- HUS dont bleed that much
Integration of viral DNA into genome of host hepatocytes

13. sporadic colon cancer tend to arise From what type of polyps?
Trochlear nerve (IV); abducens nerve (VI)
11
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Single adenomatous ones

14. What are the potassium sparing diuretics?
Increases
Amiloride - spironolactone - triamterene
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Increase in permeability of two ions with equal and opposite equilibrium potentials

15. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Downs; regurgitant AV valves - ASDs
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
frameshift mutations (missense is substitution)

16. What does sustained hand grip do to the C/V system?
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Boiling - bleach - formalin - UV irradiation
Kallmans

17. What are examples of action that decrease venous return to the heart?
Joints d/t increased purine production and thus uric acid production
Demargination of neutrophils from the vessel walls
Standing suddenly from supine position; valsalva maneuver
No

18. why is crohns disease associated with oxaloacetate kidney stones?
...
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
E. coli
Vancomycin; histamine mediated

19. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
RER; copper
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
Highly negative resting potential
SaO2 <92%

20. What are the three causes of acute MI in context of normal coronary arteries ?
25; 25
Retinitis; mononucleosis
Syringomelia
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

21. What is used to prevent vertical transmission of HIV?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
ZDV or AZT
Chlorpheniramine and diphenhydramine

22. What type of vision is myopia? In What type of patients does it improve?
Well
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Inactivates kallikrein which activates kininogen into bradykinin

23. What causes curlings ulcers?
Covalent (between two cysteines)- allows protein to withstand denaturation
The time interval between S2 and OS- the shorter the interval - the more intense
Inactivates kallikrein which activates kininogen into bradykinin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

24. What are some side effects seen in TCAs?
Demargination of neutrophils from the vessel walls
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Reiter syndrome; B27
facultative intracellular

25. what should you think of in 'smear of an oral ulcer base'?
Acute interstitial nephritis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Tzanck smear

26. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Think Hb deformation diseases
Diabetic microangiopathy
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

27. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Tibial
Retinitis; mononucleosis
APP on chrom 21 (this is why downs more susceptible)
Vagus (auricular branch); vasovagal syncope!

28. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Inactivates kallikrein which activates kininogen into bradykinin

29. What is subacute sclerosisng encephalitis caused by?
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
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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Demargination of neutrophils from the vessel walls

30. which nucleus releases serotonin?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Because gamma chains replace beta chains and then gamma chain formation wanes
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Raphe

31. What is epleronone?
Fibronectin - laminin - collagen
NF- KB; responsible for cytokine production
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Another type of aldosterone antagonist (like spironolactone)

32. What is the stabilizing force for the secondary structure of proteins?
Barium enema
Phencyclidine (PCP)
Hydrogen bonds dictate alpha or beta structure
Bronchogenic carcinoma

33. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
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
Medullary
P450 mitochondrial monooxygenase
SVT; increases vagal tone; rectus abdominis

34. ___________ is liver specific
Increases
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
glycerol kinase
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

35. what makes bruits?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Turbulence

36. why does neutrophila occur with corticosteroids?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Demargination of neutrophils from the vessel walls
Medial part
TCAs and prazosin

37. What is acanthosis nigricans associated with?
FGF and VEGF
Demargination of neutrophils from the vessel walls
Dihydropyridine sensitive Ca channels (L type)
GI malignancies and Insulin resistance (acromegal for ex)

38. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
S3 gallop; S2 to opening snap interval
gram positive organisms
Gluteus medius and minimus; positive trendelenberg
Pain reliever - reduces pain by locking substance P in the PNS

39. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
liver specific
Common peroneal; bony fractures and compression; sciatic
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

40. What does nitroprusside do to afterload? preload?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Decreases both
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
Vancomycin; histamine mediated

41. in overweight individuals What is thought to contribute to insulin resistance?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Serum FFA and serum triglyceride levels

42. Where does complement bind on the Fc region of Ig chains?
Measure of depth invasion (vertical!)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

43. Acyl coA synthetase is not...
Anti cholinergic effects of pupil dilation and lack of accomodation
Hereditary angioedema; ACE inhibitors
G to T in p53; HCC
liver specific

44. how long is substance P? What does it do?
V fib; v. failure
gram positive organisms
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
11 aa polypeptide; pain NT in CNS and PNS

45. how much percent of sodium is excreted? urea? glucose?
Large stroke volumes with ventricular contraction; aortic regurg
<1% - 55% - concentration dependent
INTRApartum Abs (ampicillin/penicillin)
MAO inhibitors; wine and cheese

46. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
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)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
P53 mutation; AD
Amiloride - spironolactone - triamterene

47. Which is faster atrial muscle or ventricular muscle?
S. aureus
Atrial
Fibrosis; macrophages
Joints d/t increased purine production and thus uric acid production

48. What does the tuberoinfundibular pathway connect? What is it responsible for?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
SS +rNA
As a CO2 carrier with the carboxylase enzyme

49. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
No
Paramyxo and influenza

50. What are the long term consequences of hydrocephalus?
Intussusception
Anterior nares
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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)