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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. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
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
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Spongiosis

2. When is acid phosphatase elevated (Name two times)?
Downs; regurgitant AV valves - ASDs
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
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Prostate tumor and increased osteoclast activity

3. What is 5- HETE and What does it do?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Leukotriene precursor and does neutrophil chemotaxis
S. saprophyticus - and s. epidermidis; novobiocin

4. Would alpha 1 agonists cause flushing? muscarinic antagonist?
I is more benign and can present later in adulthood
Terminal bronchioles; small bronchi
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
No; yes

5. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Close but purkinje system to ensure contraction in a bottom up fashion
Fat - fertile - forty - female
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

6. at four years of age - What are the social - fine motor - gross motor - and language developments?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Insulin like growth factor 1 (just another name)
Primary
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

7. What translocations can cause c - myc overexpression?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Increase in permeability of two ions with equal and opposite equilibrium potentials
8 (myc protein) with 2 - 14 - 22 (iG chains)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

8. What does hypocapnia cause in teh brain? What is hypocapnia?
TCAs and prazosin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
In the extracellular space for collagen cross linking; zinc
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

9. What is congestive hepatomegaly specific for?
Right heart failure
Elastance
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Anterior circumflex (and axillary nerve)

10. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
S. saprophyticus - and s. epidermidis; novobiocin

11. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
P53 mutation; AD
Anti centromere; anti DNA topoisomerase

12. What does Rb protein do? what chrom is it on?
S. saprophyticus - and s. epidermidis; novobiocin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Increase; decreased
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

13. which antiarrythmic is associated with blue gray discoloration ?
Faulty positioning of the genital tubercle
Serum FFA and serum triglyceride levels
Amiadarone
In ER of bile canaliculi

14. What are the two mcc of focal brain lesions in HIV positive patients?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
CMV - HSV 1 - Candida
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Atrial

15. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Susceptible; soluble (unable to be cultured in bile)
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)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

16. How is dobutamine better than dopamine?
Anterior circumflex (and axillary nerve)
Extrinsic def; instrinsic def; platelet def
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

17. which RPGN is also called pauci immune GN? why?
only up to bronchi
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
ANCA because of lack of Ig and C3 deposits on IF
GI tract; mood!

18. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Medial circumflex artery; avascular necrosis
RBF= PAH clearance/(1- hematocrit)
Spongiosis

19. nucleotide deletions do not cause missense mutations - they cause...
Covalent (between two cysteines)- allows protein to withstand denaturation
LT (LTD4 - E4 - C4) - and Ach
G to T in p53; HCC
frameshift mutations (missense is substitution)

20. which nucleus releases serotonin?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Superior larygeal; cricothyroid; recurrent laryngeal
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
Raphe

21. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Highly negative resting potential
Hyperkalemia; potassium sparing diuretics - potassium supplements
Drink plenty of fluids
Well

22. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Both sides
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
Turners`

23. What is capacitance inversely proportional to?
Tibial
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
Elastance
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

24. What is intussusception? how does ischemia and necrosis occur?
Octreotide
LT (LTD4 - E4 - C4) - and Ach
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
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

25. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Drug induced interstitial nephritis
RER; RER
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
In the extracellular space

26. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
OCPs - multiparity - breast feeding
Clindamycin; covers anaerobic oral flora and aerobic bacteria
As a CO2 carrier with the carboxylase enzyme

27. What is omalizumab and What is it used for?
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
Covalent (between two cysteines)- allows protein to withstand denaturation
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

28. why is glucagon used in beta blocker toxicitiy?
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Dissolved in plasma and attached to Hgb
Both sides

29. what hormone is structurally similar to hCG?
CMV - HSV 1 - Candida
Tibial
TSh (in testicular tumors can cause hyperthyroidism)
The time interval between S2 and OS- the shorter the interval - the more intense

30. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
RER; RER
No; yes
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

31. Which nerve lies in close proximity to the inferior thyroid artery?
G to T in p53; HCC
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Recurrent larygneal
Increase by 50% in urine osmolality

32. sporadic colon cancer tend to arise From what type of polyps?
SaO2 <92%
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Single adenomatous ones

33. Acyl coA synthetase is not...
High potassium conductance and some sodium conductance
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Localized dermatologic pain that persists for more than one month after zoster eruption
liver specific

34. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Prostate tumor and increased osteoclast activity
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

35. what kind of drug is sertraline? What is a common side effect?
GI malignancies and Insulin resistance (acromegal for ex)
Smoking
MAC complex (C5b - C9 complement deficiency)
SSRI; erectile dysfunction

36. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
SS +rNA
Standing suddenly from supine position; valsalva maneuver
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

37. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Trochlear nerve (IV); abducens nerve (VI)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
High potassium conductance and some sodium conductance

38. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

39. what chromosome is c - myc found on?
<1% - 55% - concentration dependent
Chrom 8
Decreases both
Varying; erythema nodosum is common

40. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
GI tract; mood!
Anterior nares
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
MAO inhibitors; wine and cheese

41. What causes curlings ulcers?
Folic acid treatment!
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
P450 mitochondrial monooxygenase

42. What are the two coagulase negative staphylococci? How do you distinguish them?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
glycerol kinase
S. saprophyticus - and s. epidermidis; novobiocin
4 - 4 - 9

43. What are diastolic (lowest) pressures in aorta? LV?
Acute gastric mucosal defects (superficial or full thickness)
Around 70 (normal measured diastolic pressures); 9--
Pulmonic and systemic!
ZDV or AZT

44. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
(urine PAH x urine flow rate)/plasma PAH
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Vagus (auricular branch); vasovagal syncope!

45. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Acute interstitial nephritis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

46. 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?
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)
Vagus (auricular branch); vasovagal syncope!
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
ANCA because of lack of Ig and C3 deposits on IF

47. what locations of UC increase the risk of Colon cancer?
DIC; TTP- HUS dont bleed that much
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
By vascular permeability and vasodilation
Pan colitis and right sided colitis (more than left sided and proctitis)

48. 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?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Close but purkinje system to ensure contraction in a bottom up fashion
Diabetic microangiopathy
Sudden loss of muscle tone without loss of consciousness; narcolepsy

49. which has better side effect profile - SSRI or TCA?
Nonsense; mRNA processing
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Southern - western
SSRI

50. What is hypospadias caused by?
P53 mutation; DCC is also required for adenoma to carcinoma
Abnormal closing of the urethral folds
Close but purkinje system to ensure contraction in a bottom up fashion
Increased reticulocytes