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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. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Hexokinase
Classical conditioning
Reiter syndrome; B27
Measure of depth invasion (vertical!)

2. What does L/S stand for in fetal lung maturity? When does maturity occur?
Think Hb deformation diseases
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Proteasome inhibitor; treatment for MM and waldenstroms
Inactivates kallikrein which activates kininogen into bradykinin

3. PDAs are often asymptomatic. How do you treat?
indomethacin
11
Superior larygeal; cricothyroid; recurrent laryngeal
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

4. What is Bortezomib and What is it used for?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Proteasome inhibitor; treatment for MM and waldenstroms
FGF and VEGF
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

5. What would a deflection of the membrane potential to near zero indicate?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
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
Increase in permeability of two ions with equal and opposite equilibrium potentials
Prostate tumor and increased osteoclast activity

6. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Increase by 50% in urine osmolality
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hereditary angioedema; ACE inhibitors
glycerol kinase

7. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Decreases both
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
G to T in p53; HCC

8. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
CMV - HSV 1 - Candida
frameshift mutations (missense is substitution)
Vagus (auricular branch); vasovagal syncope!
Radial nerve and deep brachial artery

9. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
Boiling - bleach - formalin - UV irradiation
Common peroneal; bony fractures and compression; sciatic
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

10. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Become beta pleated and then form neurofibrillary tangle!
Syncope - angina - dyspnea (SAD)
RER; RER

11. Where is the base of the heart? apex?
Squatting - sitting - lying supine - passive leg raising
Class I
Closer to head; closer to diaphragm
11

12. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
No and yes
S3 gallop; S2 to opening snap interval
Dihydropyridine sensitive Ca channels (L type)

13. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Elastance
SaO2 <92%
TCAs and prazosin
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

14. What causes release of myosin head from the actin filament?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
ATP binding (resets the myosin head to contract again for next binding)
8; 12
Hydrogen bonds dictate alpha or beta structure

15. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

16. in B12 deficiency - what levels in blood rise very quickly and then drop?
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
Reticulocytes
Covalent (between two cysteines)- allows protein to withstand denaturation
Trochlear nerve (IV); abducens nerve (VI)

17. what drug is useful for secretory diarrhea?
Octreotide
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
FGF and VEGF
Diabetic microangiopathy

18. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
women
Valproate
Because of the low output from heart failure - they will have increased aldosterone levels
Tzanck smear

19. What is capacitance inversely proportional to?
Insulin like growth factor 1 (just another name)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Elastance
Duration and extent of disease

20. What is the difference between additive and synergistic?
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
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
Duration and extent of disease
glycerol kinase

21. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Duration and extent of disease
Syringomelia
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

22. What antibodies are present in CREST? What is the most specific?
Vertical diplopia
No
Bile soluble which means they are bile sensitive
Anti centromere; anti DNA topoisomerase

23. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

24. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Integration of viral DNA into genome of host hepatocytes
SSRI
HSV ( also in utero: chlymadia - neisseria - group B strep)

25. 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?
Leukotriene precursor and does neutrophil chemotaxis
Lateral; RV; RA; LV
Hereditary angioedema; ACE inhibitors
Purkinje system; AV node

26. other than in pyelonephritis - where else are WBC casts seen?
FGF and VEGF
Vascular endothelium; protease
Acute interstitial nephritis
Elastance

27. What is a primary HSV 1 infection like?
RBC mass; epo levels (secondary has high)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
liver specific
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

28. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Demargination of neutrophils from the vessel walls
Ether and other organic solvents

29. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
SVT; increases vagal tone; rectus abdominis
Purkinje system; AV node
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

30. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
C3 decreased after 5-10 days; sulfonamides
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

31. What three factors effect total oxygen content of blood?
Susceptible; soluble (unable to be cultured in bile)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

32. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Turners`
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
liver specific

33. in overweight individuals What is thought to contribute to insulin resistance?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Serum FFA and serum triglyceride levels
Enterococci (e. faecalis)- found on genitalia area
Adductor

34. How do you calculate RPF from urine PAH?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
DIC; TTP- HUS dont bleed that much
(urine PAH x urine flow rate)/plasma PAH
E. coli

35. What is congestive hepatomegaly specific for?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Anti cholinergic effects of pupil dilation and lack of accomodation
Right heart failure
Spongiosis

36. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
indomethacin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

37. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Kallmans
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
The time interval between S2 and OS- the shorter the interval - the more intense

38. who bleed more DIC or TTP- HUS patients?
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
DIC; TTP- HUS dont bleed that much
RER; copper
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

39. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Medial circumflex artery; avascular necrosis
Aromatase deficiency in child
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

40. In what population does cholelithiasis occur?
Fat - fertile - forty - female
Increase in permeability of two ions with equal and opposite equilibrium potentials
CGD; t cell dysfxn (diGeorge)
Become beta pleated and then form neurofibrillary tangle!

41. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Multiple miscarriages d/t hypercoaguability
Large stroke volumes with ventricular contraction; aortic regurg
Ig A deficiency
Env genes (for getting into target cells)

42. what protects the resting heart from arrhythmias?
Fibrosis; macrophages
No; MRI
Highly negative resting potential
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

43. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria
low in serum

44. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
E. coli
Terminal bronchioles; small bronchi
Think Hb deformation diseases

45. what happens to capacitance with age?
Terminal bronchioles; small bronchi
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
...
Primary

46. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
IgE
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
HSV ( also in utero: chlymadia - neisseria - group B strep)

47. Where does complement bind on the Fc region of Ig chains?
Single adenomatous ones
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
On cardiac tissue and renal juxtaglomerular cells
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

48. What does TGF beta do? What produces it?
Turbulence
Excessive collagen formation during tissue repair in susceptible individuals
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Fibrosis; macrophages

49. What are fenfluramine - phentermine?
ANCA because of lack of Ig and C3 deposits on IF
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Appetite suppressants
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

50. how does eos release MBP to kill protozoa etc?
Radial nerve damage
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

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USMLE Prep 2

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