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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 type of antiarrythmics can protect against both atrial and ventricular arrythmias?
facultative intracellular
Class I
Increases
Faulty positioning of the genital tubercle

2. Where does lysyl oxidase act? What is the cofactor for that?
Normal; low
Syringomelia
In the extracellular space for collagen cross linking; zinc
MAC complex (C5b - C9 complement deficiency)

3. why are pregnant predisposed to cholelithiasis?
Prostate tumor and increased osteoclast activity
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
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

4. if there are keratin swirls does that mean well or poorly differentiated?
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
Trauma to stereociliated hair cells of the organ of corti
Well
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

5. What is the most common location of colonization of all s. aureus types?
Squatting - sitting - lying supine - passive leg raising
RBF= PAH clearance/(1- hematocrit)
TCAs and prazosin
Anterior nares

6. What is the most common initital symptom of ADPKD? what else?
25; 25
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Underestimation of gestational age

7. What is acanthosis nigricans associated with?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
GI malignancies and Insulin resistance (acromegal for ex)
Serum FFA and serum triglyceride levels

8. what dictates the resting membrane potential of most cells?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Atrial
Dihydropyridine sensitive Ca channels (L type)
High potassium conductance and some sodium conductance

9. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
II; I (I more abundant)
Coagulation factors are made in the liver
Minimal change disease
Hereditary angioedema; ACE inhibitors

10. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Hypothyroidism
Because of the low output from heart failure - they will have increased aldosterone levels
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Proteasome inhibitor; treatment for MM and waldenstroms

11. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Standing suddenly from supine position; valsalva maneuver
Selective alpha 1 (increases SVR)
SS +rNA

12. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Normal; low
Atrial
8 (myc protein) with 2 - 14 - 22 (iG chains)
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

13. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Prevents hepatic VLDL production
low in serum

14. what bursa is affected when on knees like a maid/gardner?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Prepatellar
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
SaO2 <92%

15. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Recurrent larygneal
Terminal bronchioles; small bronchi
Octreotide
GI tract; mood!

16. which nucleus releases serotonin?
Bile salt accumulation in urine
Prevent phagocytosis
Raphe
chronic urticaria and allergic symptoms

17. What are two common side effects of both acute and long acting nitrates? What causes them?
RBF= PAH clearance/(1- hematocrit)
Inactivates kallikrein which activates kininogen into bradykinin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Headaches and facial flushing; vasodilation in meninges and skin

18. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Increase; decreased
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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

19. which viruses require a protease?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Medullary
SS +rNA
Increases cytokine production

20. metabolism of 1 gram of protein produces How many calories? carb? fat?
Nocardia
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
4 - 4 - 9
Vancomycin

21. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Squatting - sitting - lying supine - passive leg raising
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
RER; copper

22. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Chorda tympani branch
G to T in p53; HCC

23. What type of vision is myopia? In What type of patients does it improve?
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)
Bile soluble which means they are bile sensitive
Normally close to systolic

24. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
11 aa polypeptide; pain NT in CNS and PNS
The time interval between S2 and OS- the shorter the interval - the more intense
Closer to head; closer to diaphragm

25. What does the severity of leprosy depend on?
Strength of cell mediated immune response
facultative intracellular
Clindamycin; covers anaerobic oral flora and aerobic bacteria
200-500

26. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Abnormal closing of the urethral folds
FGF and VEGF
Selective alpha 1 (increases SVR)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

27. in the LV and aorta - What are the pressures?
Normally close to systolic
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)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cluster

28. What is the difference between paranoid personality disorder and delusional disorder?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Amiloride - spironolactone - triamterene
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

29. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Right heart failure
Around 70 (normal measured diastolic pressures); 9--
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

30. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Large stroke volumes with ventricular contraction; aortic regurg
Anti - apoptotic (prevents going into apoptosis)- 18; 14
E. coli; staphylococcus saprophyticus
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

31. Where does 90% of serotonin lie? What is this NT responsible?
Acute gastric mucosal defects (superficial or full thickness)
GI tract; mood!
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Acute interstitial nephritis

32. Metronidizaole does not cover...
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
SVC and IVC; right below the aortic knob
gram positive organisms

33. what happens with LDL receptor density in statin therapy?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
25; 25
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Increases

34. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Dihydropyridine sensitive Ca channels (L type)
Vancomycin
Because of the low output from heart failure - they will have increased aldosterone levels

35. What is used to prevent vertical transmission of HIV?
glycerol kinase
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
ZDV or AZT

36. What does C1 esterase do other than inhibiting complement pathway?
Hypothyroidism
Inactivates kallikrein which activates kininogen into bradykinin
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Dihydropyridine sensitive Ca channels (L type)

37. other than proteinuria - What can cause foamy froathy urine?
AV node slowest - to allow time for diastole
When it invades the bm; carcinoma in situ
Bile salt accumulation in urine
Hypothyroidism

38. What does protein M do in Group A strep<
Duration and extent of disease
Octreotide
Prevent phagocytosis
...

39. where are the vegetations on the valves of a libman sacks endocarditis?
Demargination of neutrophils from the vessel walls
Both sides
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Anterior nares

40. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
No and 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)
Medullary

41. what commonly happens in GI in response to acute physiologic stress?
Normally close to systolic
Acute gastric mucosal defects (superficial or full thickness)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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

42. What is Tzanck smear used to detect?
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
HSV and VZV
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

43. What is difference between Arnold Chiari type I and II?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
I is more benign and can present later in adulthood
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Syringomelia

44. What are examples of action that decrease venous return to the heart?
Not lined by epithelium
Standing suddenly from supine position; valsalva maneuver
RBC mass; epo levels (secondary has high)
Downs; regurgitant AV valves - ASDs

45. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
The term used to describe decreased drug responsiveness with repeated administration
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Hereditary angioedema; ACE inhibitors
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

46. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
MAC complex (C5b - C9 complement deficiency)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

47. What are the long term consequences of hydrocephalus?
T test; chi squared
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
MAO inhibitors; wine and cheese

48. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Chrom 8
Elastance
On cardiac tissue and renal juxtaglomerular cells

49. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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)
S. saprophyticus - and s. epidermidis; novobiocin

50. What does Rb protein do? what chrom is it on?
Increases
Measure of depth invasion (vertical!)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
CGD; t cell dysfxn (diGeorge)