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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. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Relfex tachycardia; giving beta blockers
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

2. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Tzanck smear
Susceptible; soluble (unable to be cultured in bile)
Pan colitis and right sided colitis (more than left sided and proctitis)
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together

3. What is the cause of fixed splitting of S2? why?
low in serum
Tissue redistribution (out of plasma) rather than metabolism
Bronchial dilation (bronchiectasis)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

4. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Apocrine; eccrine
differentiate
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

5. what enzyme converts procarcinogens into carcinogens?
Hypo or hyper pigmentations; after tanning
P450 mitochondrial monooxygenase
ATP binding (resets the myosin head to contract again for next binding)
46 - 4N; 23 2N

6. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
MAO inhibitors; wine and cheese
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
glycerol kinase
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

7. what phase do adenosine and acetylcholine act on? doing what?
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

8. What are the first generation anti histamines?
Echinococcus granulosus; anaphylaxis
Chlorpheniramine and diphenhydramine
indomethacin
<1% - 55% - concentration dependent

9. how does neisseria cause a petechial rash?
SS +rNA
Sydenham chorea
Neisseria induced small cell vasculitis (including hands and soles)
only up to bronchi

10. metabolism of 1 gram of protein produces How many calories? carb? fat?
Pan colitis and right sided colitis (more than left sided and proctitis)
Tzanck smear
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
4 - 4 - 9

11. What is epleronone?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
DIC; TTP- HUS dont bleed that much
Increases cytokine production
Another type of aldosterone antagonist (like spironolactone)

12. What pulmonary structural change can kartageners syndrome cause?
Anti centromere; anti DNA topoisomerase
Chlorpheniramine and diphenhydramine
Circular - outside nucleus; transport proteins - rRNA - tRNA
Bronchial dilation (bronchiectasis)

13. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
ATP binding (resets the myosin head to contract again for next binding)
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
Common peroneal; bony fractures and compression; sciatic
Sudden loss of muscle tone without loss of consciousness; narcolepsy

14. When is an S4 sound normal?
Vancomycin
Well trained athletes and children
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Downs; regurgitant AV valves - ASDs

15. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
4 - 4 - 9
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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

16. What are fenfluramine - phentermine?
To pump calcium out in cardiac myocytes so that relaxation occurs
Appetite suppressants
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
Tzanck smear

17. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Hypertension - edema - and proteinuria
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Hypothyroidism

18. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Turners`
CGD; t cell dysfxn (diGeorge)
Right heart failure
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

19. 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?
11
Not lined by epithelium
46 - 4N; 23 2N
25; 25

20. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
IgE
Tissue redistribution (out of plasma) rather than metabolism
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

21. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
ATP binding (resets the myosin head to contract again for next binding)
Demargination of neutrophils from the vessel walls
Curlings ulcers
Hypertension - edema - and proteinuria

22. a patient fearing all white coats is a phenomenon of what?
Around 70 (normal measured diastolic pressures); 9--
Classical conditioning
II; I (I more abundant)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

23. there are mucus secreting cells in the bronchioles...
Ketone body production by preventing fatty acids into the mitochondria
Mean greater than median greater than mode
only up to bronchi
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

24. Acyl coA synthetase is not...
Decreases both
Excessive collagen formation during tissue repair in susceptible individuals
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
liver specific

25. why is glucagon used in beta blocker toxicitiy?
Elastance
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
In the extracellular space for collagen cross linking; zinc

26. What is hyaline arteriosclerosis usually a sign of ?
Acute interstitial nephritis
Diabetic microangiopathy
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)
Anti cholinergic effects of pupil dilation and lack of accomodation

27. What effects does cortisol have on catecholamines?
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
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Elevated GGT and macrocytosis
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

28. is Rifampin ever used as monotherapY? why either way?
Minimal change disease
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
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
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

29. do Class IC agents prolong the QT interval?
Phencyclidine (PCP)
No
Multiple miscarriages d/t hypercoaguability
Increased reticulocytes

30. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Acute interstitial nephritis
ZDV or AZT

31. What type of drug is alendronate?
Hereditary angioedema; ACE inhibitors
Biphosphonate
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

32. Which is slower AV node or ventricular muscle?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Superior larygeal; cricothyroid; recurrent laryngeal
AV node slowest - to allow time for diastole
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

33. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
Become beta pleated and then form neurofibrillary tangle!
Barium enema
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

34. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Pulmonic and systemic!

35. What is gardeners mydriasis? How is it treated?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Aromatase deficiency in child
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
NF- KB; responsible for cytokine production

36. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Excessive collagen formation during tissue repair in susceptible individuals
P450 mitochondrial monooxygenase
8 (myc protein) with 2 - 14 - 22 (iG chains)

37. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Amiloride - spironolactone - triamterene
Elastance
OCPs - multiparity - breast feeding
NF- KB; responsible for cytokine production

38. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
Acute gastric mucosal defects (superficial or full thickness)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Diabetic microangiopathy

39. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Inactivates kallikrein which activates kininogen into bradykinin
differentiate

40. PDAs are often asymptomatic. How do you treat?
In ER of bile canaliculi
indomethacin
I is more benign and can present later in adulthood
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

41. where are the vegetations on the valves of a libman sacks endocarditis?
In the extracellular space for collagen cross linking; zinc
Both sides
Common peroneal; bony fractures and compression; sciatic
hyponatremia (aldosterone activation equilibrates body volume)

42. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
No; MRI
4 - 4 - 9

43. in the LV and aorta - What are the pressures?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Normally close to systolic
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

44. what makes bruits?
Turbulence
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Skin flushing and warmth; prostaglandins; give with aspirin

45. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Vascular endothelium; protease
Brief psychotic disorder; schizophreniform; schizophrenia
8 (myc protein) with 2 - 14 - 22 (iG chains)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

46. What is suggestive of complete central DI?
Purkinje system; AV node
Increase by 50% in urine osmolality
Faulty positioning of the genital tubercle
Measles and M3 AML`

47. which has better side effect profile - SSRI or TCA?
SVC and IVC; right below the aortic knob
SSRI
Multiple miscarriages d/t hypercoaguability
Diabetic microangiopathy

48. What are the potassium sparing diuretics?
Right before diastole (filling begins)
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
Amiloride - spironolactone - triamterene
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

49. What is an abortive viral infection?
Little effect on cell and no change
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

50. What is subacute sclerosisng encephalitis caused by?
low in serum
46 - 4N; 23 2N
Apocrine; eccrine
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