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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. hypertonicity and hyperreflexity are ________________ of hydrocephalus
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
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

2. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Large stroke volumes with ventricular contraction; aortic regurg
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Bile soluble which means they are bile sensitive

3. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
hyponatremia (aldosterone activation equilibrates body volume)
women
RER; RER
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

4. What is hyaline arteriosclerosis usually a sign of ?
Tissue redistribution (out of plasma) rather than metabolism
Protamine sulfate
Circular - outside nucleus; transport proteins - rRNA - tRNA
Diabetic microangiopathy

5. which are the only glycosylated proteins in HIV virus?
MAO inhibitors; wine and cheese
Not lined by epithelium
Env genes (for getting into target cells)
Insulin like growth factor 1 (just another name)

6. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Folic acid treatment!
No; MRI
Think Hb deformation diseases
Anti - apoptotic (prevents going into apoptosis)- 18; 14

7. What is normal fibrinogen levels?
Increase; decreased
Diabetic microangiopathy
200-500
In the extracellular space for collagen cross linking; zinc

8. what drugs causes the red man syndrome? how does it occur?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Vancomycin; histamine mediated

9. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Rabies encephalitis from cave bats; rabies killed vaccines
Sickle cell; G6PD
Brief psychotic disorder; schizophreniform; schizophrenia

10. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Inhibits it
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

11. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Dissolved in plasma and attached to Hgb
Hypo or hyper pigmentations; after tanning
Large stroke volumes with ventricular contraction; aortic regurg
Because of vasodiation to skeletal muscles

12. what marker should be followed in a patient with cirrhosis?
Close but purkinje system to ensure contraction in a bottom up fashion
Leukotriene precursor and does neutrophil chemotaxis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
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)

13. How do you calculate RPF from urine PAH?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
(urine PAH x urine flow rate)/plasma PAH
Large stroke volumes with ventricular contraction; aortic regurg
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

14. What causes the blurry vision side effects in first generation anti histamines?
No; MRI
No
Anti cholinergic effects of pupil dilation and lack of accomodation
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

15. What can chronic vit A toxicity cause?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Kallmans
G to T in p53; HCC
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

16. 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?
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
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

17. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Atrial
low in serum
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

18. What is somatomedin C?
facultative intracellular
V fib; v. failure
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Insulin like growth factor 1 (just another name)

19. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
No; yes
Acute interstitial nephritis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

20. What is gardeners mydriasis? How is it treated?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Right before diastole (filling begins)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Covalent (between two cysteines)- allows protein to withstand denaturation

21. what would be a sign of absence of cardiogenic pulm edem?
Fibronectin - laminin - collagen
E. coli; staphylococcus saprophyticus
Normally close to systolic
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

22. within the right ventricle - What are maximum pressures? the pulm arter?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
RER; RER
25; 25

23. what kind of drug is sertraline? What is a common side effect?
RBC mass; epo levels (secondary has high)
Integration of viral DNA into genome of host hepatocytes
SSRI; erectile dysfunction
Skin flushing and warmth; prostaglandins; give with aspirin

24. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Amiadarone
Vagus nerve stimulation
Vagus (auricular branch); vasovagal syncope!

25. What is the most important prognostic indicator in patients with malignant melanoma?
Hypertension - edema - and proteinuria
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Measure of depth invasion (vertical!)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

26. which viruses require a protease?
Increased reticulocytes
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Radial nerve and deep brachial artery
SS +rNA

27. What is the mutation type in thalassemias? what process is defective because of this?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Nonsense; mRNA processing
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

28. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
DIC; TTP- HUS dont bleed that much
Purkinje system; AV node

29. In What type of nephritis would you see high serum eos count?
Squatting - sitting - lying supine - passive leg raising
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
Drug induced interstitial nephritis
Hereditary angioedema; ACE inhibitors

30. what virus causes pharyngoconjuctival fever?
Adeno
frameshift mutations (missense is substitution)
Elastance
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

31. What do you treat s. epidermidis with?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Chlorpheniramine and diphenhydramine
Vancomycin
Downs; regurgitant AV valves - ASDs

32. Acyl coA synthetase is not...
Because gamma chains replace beta chains and then gamma chain formation wanes
low in serum
liver specific
Reiter syndrome; B27

33. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
TCAs and prazosin
Prevents hepatic VLDL production
INTRApartum Abs (ampicillin/penicillin)
Curlings ulcers

34. which opponens muscle does ulnar innervate?
Prevents hepatic VLDL production
Adductor
No and yes
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

35. What type of mutation does aflatoxin cause? what cancer does this increase for?
Increase in permeability of two ions with equal and opposite equilibrium potentials
G to T in p53; HCC
Acute interstitial nephritis
Diabetic microangiopathy

36. how much percent of sodium is excreted? urea? glucose?
Increased reticulocytes
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Because of vasodiation to skeletal muscles
<1% - 55% - concentration dependent

37. what has the greatest effect on prognosis when treating c. diptheriae?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Measure of depth invasion (vertical!)
Gluteus maximus; difficulty getting up from seated position and climbing chair

38. other than mycobacterim wha other bacteria is acid fast?
MAO inhibitors; wine and cheese
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Reticulocytes
Nocardia

39. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
indomethacin
Prostate tumor and increased osteoclast activity
Measles and M3 AML`
Gluteus medius and minimus; positive trendelenberg

40. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
APP on chrom 21 (this is why downs more susceptible)
Right before diastole (filling begins)
FGF and VEGF

41. what protein is increased in Crohns disease? What does it do?
GI tract; mood!
Chlorpheniramine and diphenhydramine
Headaches and facial flushing; vasodilation in meninges and skin
NF- KB; responsible for cytokine production

42. Where does lysyl oxidase act? What is the cofactor for that?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
In the extracellular space for collagen cross linking; zinc
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increase lymphatic drainage!

43. What is intussusception? how does ischemia and necrosis occur?
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
Measles and M3 AML`
Enterococci (e. faecalis)- found on genitalia area
Tissue redistribution (out of plasma) rather than metabolism

44. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Joints d/t increased purine production and thus uric acid production
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Because gamma chains replace beta chains and then gamma chain formation wanes
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

45. how does achalasia present? What does barium swallow show on dilated esophagus?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Increase; decreased
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

46. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Env genes (for getting into target cells)
Adeno
Joints d/t increased purine production and thus uric acid production

47. 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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48. What is a common complication of acute pancreatitis? What is it?
Right heart failure
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Reiter syndrome; B27

49. What does nitroprusside do to afterload? preload?
Appetite suppressants
Increase; decreased
Nocardia
Decreases both

50. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Coagulation factors are made in the liver
Insulin like growth factor 1 (just another name)
Reiter syndrome; B27
HSV ( also in utero: chlymadia - neisseria - group B strep)

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USMLE Prep 2

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