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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. which virus inactivates both Rb and p53?
Well
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Ig A deficiency

2. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increase in permeability of two ions with equal and opposite equilibrium potentials
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

3. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Increase; decreased
Apocrine; eccrine

4. What type of mutation does aflatoxin cause? what cancer does this increase for?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
G to T in p53; HCC
Increase; decreased

5. What type of disease has selective proteinuria? What is found in urine? What is not?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Leukotriene precursor and does neutrophil chemotaxis
Trauma to stereociliated hair cells of the organ of corti

6. what makes bruits?
AV node slowest - to allow time for diastole
Turbulence
Bile salt accumulation in urine
Clindamycin; covers anaerobic oral flora and aerobic bacteria

7. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
T test; chi squared
Radial nerve and deep brachial artery
Varying; erythema nodosum is common
HSV ( also in utero: chlymadia - neisseria - group B strep)

8. what kind of drug is sertraline? What is a common side effect?
Prevent phagocytosis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
SSRI; erectile dysfunction

9. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
Sarcoid
RBF= PAH clearance/(1- hematocrit)
glycerol kinase

10. other than mycobacterim wha other bacteria is acid fast?
I is more benign and can present later in adulthood
Nocardia
IgE
Integration of viral DNA into genome of host hepatocytes

11. What causes vertical diplopia? horizontal?
Syncope - angina - dyspnea (SAD)
Trochlear nerve (IV); abducens nerve (VI)
PDA open
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

12. h1 receptor anatagonists are not effective in treatment of asthma only for...
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
As a CO2 carrier with the carboxylase enzyme
Southern - western
chronic urticaria and allergic symptoms

13. What is the mc manifestation of CMV in HIV patient? immunocompetent?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
T test; chi squared
Retinitis; mononucleosis

14. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Brief psychotic disorder; schizophreniform; schizophrenia
(urine PAH x urine flow rate)/plasma PAH
II; I (I more abundant)

15. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Syncope - angina - dyspnea (SAD)
LT (LTD4 - E4 - C4) - and Ach
Kallmans
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

16. what phase do adenosine and acetylcholine act on? doing what?
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Measles and M3 AML`
Normally close to systolic

17. ___________ is liver specific
IgE
As a CO2 carrier with the carboxylase enzyme
glycerol kinase
Paramyxo and influenza

18. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Amiadarone
Gluteus maximus; difficulty getting up from seated position and climbing chair

19. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Bronchogenic carcinoma
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
GI malignancies and Insulin resistance (acromegal for ex)

20. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
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)
Tzanck smear
Single adenomatous ones
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

21. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Drink plenty of fluids
11 aa polypeptide; pain NT in CNS and PNS
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)

22. why does liver dysfunction cause coagulation disorders?
Atrial
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Coagulation factors are made in the liver

23. What causes curlings ulcers?
indomethacin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Faulty positioning of the genital tubercle
Circular - outside nucleus; transport proteins - rRNA - tRNA

24. What is the precursor protein to beta amyloid and On what chromosome is it found?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
RR-1/RR
P53 mutation; DCC is also required for adenoma to carcinoma
APP on chrom 21 (this is why downs more susceptible)

25. Where is aromatase used?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Not lined by epithelium
MAC complex (C5b - C9 complement deficiency)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

26. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Vascular endothelium; protease
Mean greater than median greater than mode
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Medial part

27. What are the long term consequences of hydrocephalus?
Downs; regurgitant AV valves - ASDs
Hypo or hyper pigmentations; after tanning
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
RR-1/RR

28. What is acanthosis nigricans associated with?
women
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)
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
GI malignancies and Insulin resistance (acromegal for ex)

29. 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?
Prepatellar
Intussusception
Superior larygeal; cricothyroid; recurrent laryngeal
Covalent (between two cysteines)- allows protein to withstand denaturation

30. What is used to prevent vertical transmission of HIV?
No; MRI
Recurrent larygneal
ZDV or AZT
Single adenomatous ones

31. 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)
Insulin like growth factor 1 (just another name)
8; 12
Ceftriaxone; azithromycin

32. do Class IC agents prolong the QT interval?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
No
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
Anti - apoptotic (prevents going into apoptosis)- 18; 14

33. How do you calculate RPF from urine PAH?
Coagulation factors are made in the liver
Southern - western
(urine PAH x urine flow rate)/plasma PAH
Right before diastole (filling begins)

34. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
No
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
Lateral; RV; RA; LV
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

35. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Aromatase deficiency in child
S. saprophyticus - and s. epidermidis; novobiocin

36. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
V fib; v. failure
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Serum creatine kinase; reperfusion injury causes necrosis
Minimal change disease

37. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Strength of cell mediated immune response
Inactivates kallikrein which activates kininogen into bradykinin
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Skin flushing and warmth; prostaglandins; give with aspirin

38. which nerve provides innervation for plantar flexion and inversion?
Superior larygeal; cricothyroid; recurrent laryngeal
Increases cytokine production
Selective alpha 1 (increases SVR)
Tibial

39. What is capacitance inversely proportional to?
Vagus nerve stimulation
low in serum
Elastance
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

40. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Gluteus medius and minimus; positive trendelenberg
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

41. What is a primary HSV 1 infection like?
Coagulation factors are made in the liver
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
46 - 4N; 23 2N
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

42. What is suggestive of complete central DI?
Large stroke volumes with ventricular contraction; aortic regurg
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Increase by 50% in urine osmolality
Localized dermatologic pain that persists for more than one month after zoster eruption

43. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Rabies encephalitis from cave bats; rabies killed vaccines
TSh (in testicular tumors can cause hyperthyroidism)
G to T in p53; HCC

44. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
liver specific
TSh (in testicular tumors can cause hyperthyroidism)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

45. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Increase; decreased
Valproate
Pain reliever - reduces pain by locking substance P in the PNS

46. 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
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

47. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
indomethacin
(urine PAH x urine flow rate)/plasma PAH
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

48. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Decreases both
No; MRI
Common peroneal; bony fractures and compression; sciatic

49. How do you treat gonococcal infection? chlymadia?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
When it invades the bm; carcinoma in situ
Because of the low output from heart failure - they will have increased aldosterone levels
Ceftriaxone; azithromycin

50. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
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
Medullary
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Vagus nerve stimulation

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USMLE Prep 2

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