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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. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
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
Serum FFA and serum triglyceride levels
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

2. which antiarrythmic is associated with blue gray discoloration ?
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
hyponatremia (aldosterone activation equilibrates body volume)
Amiadarone
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)

3. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Vascular endothelium; protease
Cluster
CGD; t cell dysfxn (diGeorge)

4. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Anti centromere; anti DNA topoisomerase
Pan colitis and right sided colitis (more than left sided and proctitis)

5. what receptors do first generation anti histamines block?
Amiadarone
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

6. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
P53 mutation; AD
Reticulocytes
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

7. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Closer to head; closer to diaphragm
Mean greater than median greater than mode
Demargination of neutrophils from the vessel walls

8. what makes bruits?
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
Valproate
Turbulence
TSh (in testicular tumors can cause hyperthyroidism)

9. at three years of age What are social - fine motor - gross motor and language developments?
In the extracellular space
When it invades the bm; carcinoma in situ
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Squatting - sitting - lying supine - passive leg raising

10. What is the mcc of extrinsic allergic asthma?
Little effect on cell and no change
The term used to describe decreased drug responsiveness with repeated administration
Inhaled animal dander allergens
gram positive organisms

11. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
C3 decreased after 5-10 days; sulfonamides
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Because of the low output from heart failure - they will have increased aldosterone levels

12. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Superior larygeal; cricothyroid; recurrent laryngeal
Kallmans
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

13. What are some side effects seen in TCAs?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Smoking
CMV - HSV 1 - Candida

14. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Relfex tachycardia; giving beta blockers
Trochlear nerve (IV); abducens nerve (VI)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

15. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Acute gastric mucosal defects (superficial or full thickness)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
RER; copper

16. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Biphosphonate
RBF= PAH clearance/(1- hematocrit)
Env genes (for getting into target cells)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

17. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Regular insulin (Not fast acting - regular better)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Prevents hepatic VLDL production

18. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Reticulocytes
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
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

19. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
No; yes
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)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

20. What does C1 esterase do other than inhibiting complement pathway?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Adductor
Inactivates kallikrein which activates kininogen into bradykinin
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

21. what should you think of in 'smear of an oral ulcer base'?
Medullary
Tzanck smear
Headaches and facial flushing; vasodilation in meninges and skin
SVC and IVC; right below the aortic knob

22. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Adductor
women
Bronchogenic carcinoma
Increase in permeability of two ions with equal and opposite equilibrium potentials

23. What is used to treat heparin toxicity?
liver specific
Protamine sulfate
I is more benign and can present later in adulthood
Demargination of neutrophils from the vessel walls

24. biotin is used By what in tissues responsible for gluconeogenesis
Well
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Sarcoid
As a CO2 carrier with the carboxylase enzyme

25. What is the mc location for avascular necrosis? What is it associated with?
46 - 4N; 23 2N
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Become beta pleated and then form neurofibrillary tangle!
Prepatellar

26. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
TSh (in testicular tumors can cause hyperthyroidism)
Become beta pleated and then form neurofibrillary tangle!
No; MRI

27. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
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
Medullary
The term used to describe decreased drug responsiveness with repeated administration
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

28. When is an S4 sound normal?
Increase lymphatic drainage!
Well trained athletes and children
indomethacin
Closer to head; closer to diaphragm

29. What are some of the permissive effects of cortisol?
11 aa polypeptide; pain NT in CNS and PNS
Proteasome inhibitor; treatment for MM and waldenstroms
Vertical diplopia
Increases bronchial and vascular smooth muscle reactivity to catecholamines

30. what drug is useful for secretory diarrhea?
Covalent (between two cysteines)- allows protein to withstand denaturation
Octreotide
Initiation - pointing; pincer grasp; walking; mama/dada
Adductor

31. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
Recurrent larygneal
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increase lymphatic drainage!

32. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Syringomelia
Large stroke volumes with ventricular contraction; aortic regurg
Well

33. name three pathological states that present with large tongues.
Bronchial dilation (bronchiectasis)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Susceptible; soluble (unable to be cultured in bile)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

34. 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?
I is more benign and can present later in adulthood
indomethacin
46 - 4N; 23 2N
transcription activation/suppression

35. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Drink plenty of fluids
Biphosphonate
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

36. What is the presentation of angioedema? Where is most commonly affected?
GI tract; mood!
Ig A deficiency
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

37. other than parvo B19 - what else is associated with red cell aplasia?
Prostate tumor and increased osteoclast activity
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Thymic tumor

38. What can too much IgA in serum produces?
In the extracellular space
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Hypo or hyper pigmentations; after tanning

39. why does hypothyroidism cause increased CPK levels?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

40. What is capacitance inversely proportional to?
Duration and extent of disease
Elastance
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

41. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
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
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Enterococci (e. faecalis)- found on genitalia area
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

42. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
Vagus (auricular branch); vasovagal syncope!
Radial nerve damage
Single adenomatous ones

43. how does increased ICP result in curlings ulcers?
Tzanck smear
Vagus nerve stimulation
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

44. why is glucagon used in beta blocker toxicitiy?
Retinitis; mononucleosis
Class I
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Echinococcus granulosus; anaphylaxis

45. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Coagulation factors are made in the liver
Gluteus maximus; difficulty getting up from seated position and climbing chair
Purkinje system; AV node
CGD; t cell dysfxn (diGeorge)

46. SIADH patients have normal blood volume but...
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
hyponatremia (aldosterone activation equilibrates body volume)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Right before diastole (filling begins)

47. Metronidizaole does not cover...
gram positive organisms
Barium enema
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Clindamycin; covers anaerobic oral flora and aerobic bacteria

48. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Adductor
Relfex tachycardia; giving beta blockers
Gluteus medius and minimus; positive trendelenberg

49. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
ZDV or AZT
Raphe
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

50. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Apocrine; eccrine
Syncope - angina - dyspnea (SAD)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)