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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 drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Increase; decreased
When it invades the bm; carcinoma in situ
Pulmonary hypertension

2. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Circular - outside nucleus; transport proteins - rRNA - tRNA
HSV ( also in utero: chlymadia - neisseria - group B strep)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

3. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
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)

4. What is the preferred treatment for DKA?
Cluster
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Inhaled animal dander allergens
Regular insulin (Not fast acting - regular better)

5. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
No (unlike adenomyosis); yes
Ketone body production by preventing fatty acids into the mitochondria
Chrom 8

6. within the right ventricle - What are maximum pressures? the pulm arter?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
RER; copper
25; 25
Inactivates kallikrein which activates kininogen into bradykinin

7. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Normal; low
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Nocardia

8. what drugs causes the red man syndrome? how does it occur?
Well trained athletes and children
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
INTRApartum Abs (ampicillin/penicillin)
Vancomycin; histamine mediated

9. what happens with LDL receptor density in statin therapy?
Measles and M3 AML`
Prostate tumor and increased osteoclast activity
No (unlike adenomyosis); yes
Increases

10. PDAs are often asymptomatic. How do you treat?
SVT; increases vagal tone; rectus abdominis
Anti centromere; anti DNA topoisomerase
MAO inhibitors; wine and cheese
indomethacin

11. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Terminal bronchioles; small bronchi
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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

12. the rate of blood flow of which two circulations must equal each other at all times?
Acute gastric mucosal defects (superficial or full thickness)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Pulmonic and systemic!
E6 and E7 of HPV knock off p53 and Rb suppressor genes

13. what makes bruits?
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
Turbulence
OCPs - multiparity - breast feeding
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)

14. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Fibrosis; macrophages
Phencyclidine (PCP)

15. What is tachyphylaxis?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Increases cytokine production
AV node slowest - to allow time for diastole
The term used to describe decreased drug responsiveness with repeated administration

16. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
8; 12
Raphe
Pulmonic and systemic!

17. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Vancomycin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

18. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Chorda tympani branch
Hereditary angioedema; ACE inhibitors
INTRApartum Abs (ampicillin/penicillin)

19. What does the tuberoinfundibular pathway connect? What is it responsible for?
Atrial
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Not lined by epithelium
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

20. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Excessive collagen formation during tissue repair in susceptible individuals
Well
Radial nerve damage

21. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
Smoking
Measure of depth invasion (vertical!)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

22. other than mycobacterim wha other bacteria is acid fast?
Extrinsic def; instrinsic def; platelet def
G to T in p53; HCC
Nocardia
Skin flushing and warmth; prostaglandins; give with aspirin

23. What actions increase venous return?
Medullary
Squatting - sitting - lying supine - passive leg raising
Inhibits it
INTRApartum Abs (ampicillin/penicillin)

24. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Cluster
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

25. In what form are mitochondrial DNA? What do they transcribe?
Vancomycin; histamine mediated
Coagulation factors are made in the liver
Circular - outside nucleus; transport proteins - rRNA - tRNA
Purkinje system; AV node

26. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Normal; low
11 aa polypeptide; pain NT in CNS and PNS

27. What is the most common initital symptom of ADPKD? what else?
Terminal bronchioles; small bronchi
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
No
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

28. which nucleus releases serotonin?
Raphe
Gluteus maximus; difficulty getting up from seated position and climbing chair
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

29. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
No
Turbulence
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

30. How do you treat gonococcal infection? chlymadia?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Ceftriaxone; azithromycin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

31. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
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
Gluteus medius and minimus; positive trendelenberg
Ether and other organic solvents

32. is Rifampin ever used as monotherapY? why either way?
Prevents hepatic VLDL production
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
Insulin like growth factor 1 (just another name)
No

33. what vessel would a fracture to the neck of the of the humerus damage?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Anterior circumflex (and axillary nerve)
Curlings ulcers
Large stroke volumes with ventricular contraction; aortic regurg

34. How is dobutamine better than dopamine?
Coagulation factors are made in the liver
Localized dermatologic pain that persists for more than one month after zoster eruption
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

35. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
INTRApartum Abs (ampicillin/penicillin)
PDA open
Syringomelia

36. other than proteinuria - What can cause foamy froathy urine?
liver specific
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
NF- KB; responsible for cytokine production
Bile salt accumulation in urine

37. what dictates the resting membrane potential of most cells?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Anti centromere; anti DNA topoisomerase
Medial circumflex artery; avascular necrosis
High potassium conductance and some sodium conductance

38. sporadic colon cancer tend to arise From what type of polyps?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Strength of cell mediated immune response
Single adenomatous ones

39. What is acanthosis nigricans associated with?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Prepatellar
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
GI malignancies and Insulin resistance (acromegal for ex)

40. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
low in serum

41. 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?
Normally close to systolic
On cardiac tissue and renal juxtaglomerular cells
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

42. on What part of the clavicle does the SCM attach?
Medial part
differentiate
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Gluteus maximus; difficulty getting up from seated position and climbing chair

43. IL4 is used for isotypye switching to what?
Terminal bronchioles; small bronchi
IgE
Turners`
Purkinje system; AV node

44. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Medial circumflex artery; avascular necrosis
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Curlings ulcers
Regular insulin (Not fast acting - regular better)

45. Which is faster purkinje system or atrial muscle?
Biphosphonate
Trochlear nerve (IV); abducens nerve (VI)
Close but purkinje system to ensure contraction in a bottom up fashion
Increase in permeability of two ions with equal and opposite equilibrium potentials

46. how does neisseria cause a petechial rash?
MAO inhibitors; wine and cheese
Pulmonary hypertension
Neisseria induced small cell vasculitis (including hands and soles)
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

47. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Increase; decreased
Demargination of neutrophils from the vessel walls

48. What are the skin presentation in sarcoid?
(urine PAH x urine flow rate)/plasma PAH
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
4 - 4 - 9
Varying; erythema nodosum is common

49. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Sydenham chorea
Apocrine; eccrine
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
No; MRI

50. how does increased ICP result in curlings ulcers?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Vagus nerve stimulation
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

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USMLE Prep 2

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