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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. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Neisseria induced small cell vasculitis (including hands and soles)
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Bile soluble which means they are bile sensitive

2. What pulmonary structural change can kartageners syndrome cause?
Mean greater than median greater than mode
ANCA because of lack of Ig and C3 deposits on IF
Bronchial dilation (bronchiectasis)
8 (myc protein) with 2 - 14 - 22 (iG chains)

3. what induces bronchial squamous metaplasia?
V fib; v. failure
Smoking
SaO2 <92%
Intussusception

4. how can HAV be inactivated?
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)
SSRI
Covalent (between two cysteines)- allows protein to withstand denaturation
Boiling - bleach - formalin - UV irradiation

5. which antiarrythmic is associated with blue gray discoloration ?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Amiadarone
Skin flushing and warmth; prostaglandins; give with aspirin

6. What causes curlings ulcers?
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)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Biphosphonate
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

7. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Valproate
Vagus nerve stimulation
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

8. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
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)
RER; copper
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
frameshift mutations (missense is substitution)

9. How can renal blood flow be calculated from RPF?
46 - 4N; 23 2N
PDA open
Echinococcus granulosus; anaphylaxis
RBF= PAH clearance/(1- hematocrit)

10. What is pickwickian syndrome? What are the lab findings?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Trauma to stereociliated hair cells of the organ of corti
V fib; v. failure

11. What are the three causes of acute MI in context of normal coronary arteries ?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
11
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Adeno

12. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
SVC and IVC; right below the aortic knob
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Standing suddenly from supine position; valsalva maneuver
only up to bronchi

13. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
TCAs and prazosin
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)
chronic urticaria and allergic symptoms
Hypothyroidism

14. What are the acute effects of corticosteroids on the CBC?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
8 (myc protein) with 2 - 14 - 22 (iG chains)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
INTRApartum Abs (ampicillin/penicillin)

15. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Radial nerve and deep brachial artery
Vancomycin; histamine mediated
Hereditary angioedema; ACE inhibitors

16. Acyl coA synthetase is not...
liver specific
differentiate
Spongiosis
Medullary

17. which virus inactivates both Rb and p53?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Hydrogen bonds dictate alpha or beta structure
P53 mutation; AD
E6 and E7 of HPV knock off p53 and Rb suppressor genes

18. What are fenfluramine - phentermine?
glycerol kinase
No; MRI
Appetite suppressants
NF- KB; responsible for cytokine production

19. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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20. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Susceptible; soluble (unable to be cultured in bile)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
only up to bronchi

21. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Myasthenia gravis
Medial part
Reiter syndrome; B27
HSV ( also in utero: chlymadia - neisseria - group B strep)

22. 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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Susceptible; soluble (unable to be cultured in bile)
S3 gallop; S2 to opening snap interval

23. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Acute interstitial nephritis
Medullary
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
Intussusception

24. why are pregnant predisposed to cholelithiasis?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
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
Both sides
low in serum

25. what immune deficiency causes recurrent neisseria infections?
Medial circumflex artery; avascular necrosis
MAC complex (C5b - C9 complement deficiency)
Localized dermatologic pain that persists for more than one month after zoster eruption
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

26. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
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
Anti cholinergic effects of pupil dilation and lack of accomodation
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

27. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

28. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Protamine sulfate
Highly negative resting potential
Increases cytokine production

29. on which chromosome is wilms tumor found?
Paramyxo and influenza
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
11
HSV and VZV

30. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
HSV ( also in utero: chlymadia - neisseria - group B strep)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

31. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
In the extracellular space
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Valproate

32. What does anti phospholipid syndrome in SLE patients predispose them to?
Medullary
Multiple miscarriages d/t hypercoaguability
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Bronchogenic carcinoma

33. which has better side effect profile - SSRI or TCA?
Amiadarone
Prevent phagocytosis
SSRI
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

34. What does NF- KB do?
RR-1/RR
Dihydropyridine sensitive Ca channels (L type)
Increases cytokine production
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

35. What is damaged in early syringomelia? later?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Spongiosis
Regular insulin (Not fast acting - regular better)

36. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hypo or hyper pigmentations; after tanning
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

37. 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?
II; I (I more abundant)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Decreases both
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

38. what happens with LDL receptor density in statin therapy?
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)
differentiate
Increases
Medial part

39. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
indomethacin
Prostate tumor and increased osteoclast activity
Fibronectin - laminin - collagen

40. What is contraindicated in toxic mega colon?
Hereditary angioedema; ACE inhibitors
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Prostate tumor and increased osteoclast activity

41. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
frameshift mutations (missense is substitution)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

42. do Class IC agents prolong the QT interval?
liver specific
No
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
In the extracellular space

43. which nerve provides innervation for plantar flexion and inversion?
Medullary
Skin flushing and warmth; prostaglandins; give with aspirin
Classical conditioning
Tibial

44. What causes vertical diplopia? horizontal?
AV node slowest - to allow time for diastole
TSh (in testicular tumors can cause hyperthyroidism)
facultative intracellular
Trochlear nerve (IV); abducens nerve (VI)

45. what would be a sign of absence of cardiogenic pulm edem?
GI tract; mood!
Common peroneal; bony fractures and compression; sciatic
Relfex tachycardia; giving beta blockers
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

46. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Bronchial dilation (bronchiectasis)
Apocrine; eccrine
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

47. hypertonicity and hyperreflexity are ________________ of hydrocephalus
8; 12
Reticulocytes
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Insulin like growth factor 1 (just another name)

48. What is an abortive viral infection?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Diabetic microangiopathy
Little effect on cell and no change
When it invades the bm; carcinoma in situ

49. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Increases
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Inactivates kallikrein which activates kininogen into bradykinin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

50. within the right ventricle - What are maximum pressures? the pulm arter?
SVC and IVC; right below the aortic knob
Ether and other organic solvents
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
25; 25