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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 agonists reduce the gradient across the LV outflow tract?
In ER of bile canaliculi
Vancomycin
GI tract; mood!
Selective alpha 1 (increases SVR)

2. What does TGF beta do? What produces it?
Not lined by epithelium
women
Fibrosis; macrophages
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

3. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
To pump calcium out in cardiac myocytes so that relaxation occurs
Echinococcus granulosus; anaphylaxis
Vertical diplopia
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

4. What are two indicators of chronic alcohol consumption?
Another type of aldosterone antagonist (like spironolactone)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Elevated GGT and macrocytosis
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

5. after a thrombus extraction - what serum enzyme shoots up and why?
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
Serum creatine kinase; reperfusion injury causes necrosis
Pain reliever - reduces pain by locking substance P in the PNS
Sudden loss of muscle tone without loss of consciousness; narcolepsy

6. What does Rb protein do? what chrom is it on?
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
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

7. 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
RER; copper
Inhaled animal dander allergens
Insulin like growth factor 1 (just another name)

8. which cells produce surfactant? which ones mediate gas exchange?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Kallmans
II; I (I more abundant)
In the extracellular space for collagen cross linking; zinc

9. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
200-500
glycerol kinase
Elastance
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

10. What is tachyphylaxis?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
The term used to describe decreased drug responsiveness with repeated administration
MAC complex (C5b - C9 complement deficiency)
CGD; t cell dysfxn (diGeorge)

11. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
INTRApartum Abs (ampicillin/penicillin)
P53 mutation; AD
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

12. h1 receptor anatagonists are not effective in treatment of asthma only for...
Pulmonary hypertension
Trochlear nerve (IV); abducens nerve (VI)
Ig A deficiency
chronic urticaria and allergic symptoms

13. What is the mutation type in thalassemias? what process is defective because of this?
C3 decreased after 5-10 days; sulfonamides
Nonsense; mRNA processing
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
hyponatremia (aldosterone activation equilibrates body volume)

14. what vessel would a fracture to the neck of the of the humerus damage?
46 - 4N; 23 2N
Tibial
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Anterior circumflex (and axillary nerve)

15. other than mycobacterim wha other bacteria is acid fast?
SS +rNA
Nocardia
In the extracellular space for collagen cross linking; zinc
Terminal bronchioles; small bronchi

16. What does L/S stand for in fetal lung maturity? When does maturity occur?
Chrom 8
E. coli; staphylococcus saprophyticus
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Chorda tympani branch

17. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Smoking
Brief psychotic disorder; schizophreniform; schizophrenia
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

18. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
SSRI; erectile dysfunction
Adductor
Acute gastric mucosal defects (superficial or full thickness)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

19. which staphylococci can do mannitol fermaentation?
S. aureus
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
No (unlike adenomyosis); yes
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

20. What pulmonary structural change can kartageners syndrome cause?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Bronchial dilation (bronchiectasis)
Inhibits it
No; MRI

21. 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)
Trauma to stereociliated hair cells of the organ of corti
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Right heart failure

22. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Decreases both
S. saprophyticus - and s. epidermidis; novobiocin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

23. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Retinitis; mononucleosis
In the extracellular space
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
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

24. Acyl coA synthetase is not...
Closer to head; closer to diaphragm
liver specific
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
RBC mass; epo levels (secondary has high)

25. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Tissue redistribution (out of plasma) rather than metabolism
SSRI; erectile dysfunction
Gluteus medius and minimus; positive trendelenberg

26. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
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
11
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
T test; chi squared

27. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Purkinje system; AV node
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Regular insulin (Not fast acting - regular better)
No and yes

28. What causes vertical diplopia? horizontal?
Fat - fertile - forty - female
In ER of bile canaliculi
Trochlear nerve (IV); abducens nerve (VI)
Purkinje system; AV node

29. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Elevated GGT and macrocytosis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Anterior circumflex (and axillary nerve)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

30. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Fibronectin - laminin - collagen
Sickle cell; G6PD
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

31. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Initiation - pointing; pincer grasp; walking; mama/dada

32. What does nitroprusside do to afterload? preload?
Minimal change disease
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Decreases both
Neisseria induced small cell vasculitis (including hands and soles)

33. What three pathogens cause infectious esophagitis in HIV positive patients?
Mean greater than median greater than mode
CMV - HSV 1 - Candida
T test; chi squared
No (unlike adenomyosis); yes

34. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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
Insulin like growth factor 1 (just another name)

35. what organ would an activating mutation in PRPP synthetase effect?
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
Joints d/t increased purine production and thus uric acid production
Barium enema
Rabies encephalitis from cave bats; rabies killed vaccines

36. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Raphe
To pump calcium out in cardiac myocytes so that relaxation occurs

37. What does sustained hand grip do to the C/V system?
SS +rNA
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
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
In ER of bile canaliculi

38. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
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
Phencyclidine (PCP)
Abnormal closing of the urethral folds

39. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Because gamma chains replace beta chains and then gamma chain formation wanes
To pump calcium out in cardiac myocytes so that relaxation occurs
Purkinje system; AV node
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

40. What is normal fibrinogen levels?
200-500
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
Insulin like growth factor 1 (just another name)
Gluteus maximus; difficulty getting up from seated position and climbing chair

41. what clinical findings help distinguish small cell carcinoma?
No and yes
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
liver specific
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

42. non ceruloplasmin deposition - ceruloplasmin is...
ATP binding (resets the myosin head to contract again for next binding)
Curlings ulcers
Retinitis; mononucleosis
low in serum

43. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Anti centromere; anti DNA topoisomerase
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
LT (LTD4 - E4 - C4) - and Ach

44. What is epleronone?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Another type of aldosterone antagonist (like spironolactone)
Vancomycin; histamine mediated
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

45. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Hypothyroidism
Skin flushing and warmth; prostaglandins; give with aspirin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

46. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Biphosphonate
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
indomethacin

47. What can cause virilization of a mother during pregnancy?
Tzanck smear
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Aromatase deficiency in child
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

48. prostaglandin synthesis keeps...
PDA open
Well
Fibrosis; macrophages
Faulty positioning of the genital tubercle

49. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
No; yes
C3 decreased after 5-10 days; sulfonamides
Minimal change disease
Reiter syndrome; B27

50. why does neutrophila occur with corticosteroids?
Relfex tachycardia; giving beta blockers
Demargination of neutrophils from the vessel walls
Excessive collagen formation during tissue repair in susceptible individuals
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)