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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 should you think of in 'smear of an oral ulcer base'?
Inhaled animal dander allergens
Tzanck smear
Intussusception
MAC complex (C5b - C9 complement deficiency)

2. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
SSRI
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Anti cholinergic effects of pupil dilation and lack of accomodation

3. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
V fib; v. failure
11
Leukotriene precursor and does neutrophil chemotaxis

4. why is glucagon used in beta blocker toxicitiy?
8; 12
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
IgE
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

5. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Purkinje system; AV node
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Strength of cell mediated immune response

6. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
II; I (I more abundant)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Joints d/t increased purine production and thus uric acid production
Prevents hepatic VLDL production

7. What is a cord factor and Which bugs have it? How do they appear on culture?
Sickle cell; G6PD
Proteasome inhibitor; treatment for MM and waldenstroms
Initiation - pointing; pincer grasp; walking; mama/dada
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

8. Which is faster atrial muscle or ventricular muscle?
Anti centromere; anti DNA topoisomerase
Atrial
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

9. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Strength of cell mediated immune response
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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

10. What is a clara cell?
E. coli; staphylococcus saprophyticus
Class I
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Mean greater than median greater than mode

11. if there are keratin swirls does that mean well or poorly differentiated?
Apocrine; eccrine
Acute interstitial nephritis
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Well

12. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Sickle cell; G6PD
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
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Fat - fertile - forty - female

13. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Gluteus maximus; difficulty getting up from seated position and climbing chair
Fibronectin - laminin - collagen
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

14. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Varying; erythema nodosum is common
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Faulty positioning of the genital tubercle
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

15. What is 5- HETE and What does it do?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Leukotriene precursor and does neutrophil chemotaxis
By vascular permeability and vasodilation

16. What is the mc malignancy in asbestosis?
Highly negative resting potential
Bronchogenic carcinoma
Thymic tumor
On cardiac tissue and renal juxtaglomerular cells

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

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18. In What type of nephritis would you see high serum eos count?
Amiadarone
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Drug induced interstitial nephritis
Echinococcus granulosus; anaphylaxis

19. which opponens muscle does ulnar innervate?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Adductor
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

20. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Not lined by epithelium
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Sarcoid
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

21. What is normal fibrinogen levels?
Medial part
Minimal change disease
200-500
Duration and extent of disease

22. which RPGN is also called pauci immune GN? why?
Reiter syndrome; B27
ANCA because of lack of Ig and C3 deposits on IF
transcription activation/suppression
Hydrogen bonds dictate alpha or beta structure

23. what induces bronchial squamous metaplasia?
Proteasome inhibitor; treatment for MM and waldenstroms
Elevated GGT and macrocytosis
Smoking
Well trained athletes and children

24. What effects does cortisol have on catecholamines?
Not lined by epithelium
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

25. the rate of blood flow of which two circulations must equal each other at all times?
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
Pulmonic and systemic!
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

26. neisseria are...
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
The term used to describe decreased drug responsiveness with repeated administration
Reticulocytes
facultative intracellular

27. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
PDA open
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

28. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

29. which has better side effect profile - SSRI or TCA?
SSRI
Barium enema
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Serum FFA and serum triglyceride levels

30. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Purkinje system; AV node
Right before diastole (filling begins)
women
Measles and M3 AML`

31. why is crohns disease associated with oxaloacetate kidney stones?
CMV - HSV 1 - Candida
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Well trained athletes and children
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

32. what nerve and artery course along the posterior aspect of the humerus?
On cardiac tissue and renal juxtaglomerular cells
Radial nerve and deep brachial artery
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
TSh (in testicular tumors can cause hyperthyroidism)

33. what defines hypoxemia?
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
SaO2 <92%
Measure of depth invasion (vertical!)

34. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Vascular endothelium; protease
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Adductor

35. What does p53 do? what chrom is it on?
Barium enema
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Dihydropyridine sensitive Ca channels (L type)

36. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Skin flushing and warmth; prostaglandins; give with aspirin
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Neisseria induced small cell vasculitis (including hands and soles)

37. What does extended consumption of appetite suppressants lead to?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Pulmonary hypertension
No; yes
Covalent (between two cysteines)- allows protein to withstand denaturation

38. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Fibronectin - laminin - collagen
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

39. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
chronic urticaria and allergic symptoms
Skin flushing and warmth; prostaglandins; give with aspirin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
On cardiac tissue and renal juxtaglomerular cells

40. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
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)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
No (unlike adenomyosis); yes
I is more benign and can present later in adulthood

41. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
In the extracellular space for collagen cross linking; zinc
Turners`
Increase lymphatic drainage!

42. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Inactivates kallikrein which activates kininogen into bradykinin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Superior larygeal; cricothyroid; recurrent laryngeal

43. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Ketone body production by preventing fatty acids into the mitochondria
No (unlike adenomyosis); yes
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

44. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
Neisseria induced small cell vasculitis (including hands and soles)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
S3 gallop; S2 to opening snap interval

45. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
8; 12
Hypo or hyper pigmentations; after tanning
CGD; t cell dysfxn (diGeorge)

46. What type of vision is myopia? In What type of patients does it improve?
HSV and VZV
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
SaO2 <92%

47. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Hypertension - edema - and proteinuria
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

48. what happens to capacitance with age?
Neisseria induced small cell vasculitis (including hands and soles)
Recurrent larygneal
...
Right heart failure

49. What is damaged in early syringomelia? later?
P53 mutation; AD
Pain reliever - reduces pain by locking substance P in the PNS
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

50. 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
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Inhibits it
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects