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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. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
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)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increases

2. What type of mutation does aflatoxin cause? what cancer does this increase for?
OCPs - multiparity - breast feeding
No (unlike adenomyosis); yes
G to T in p53; HCC
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

3. What are examples of action that decrease venous return to the heart?
Rabies encephalitis from cave bats; rabies killed vaccines
Standing suddenly from supine position; valsalva maneuver
No and yes
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

4. is Rifampin ever used as monotherapY? why either way?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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
APP on chrom 21 (this is why downs more susceptible)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

5. what dictates the resting membrane potential of most cells?
Vagus nerve stimulation
High potassium conductance and some sodium conductance
P53 mutation; AD
E. coli; staphylococcus saprophyticus

6. Where is the base of the heart? apex?
Covalent (between two cysteines)- allows protein to withstand denaturation
No
Closer to head; closer to diaphragm
Relfex tachycardia; giving beta blockers

7. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
P53 mutation; AD
INTRApartum Abs (ampicillin/penicillin)
Increase lymphatic drainage!

8. What is the mainstay treatment for acute mania?
Increase by 50% in urine osmolality
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Prepatellar
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

9. which viruses require a protease?
SS +rNA
Enterococci (e. faecalis)- found on genitalia area
Curlings ulcers
Atrial

10. why does variocele occur more in left side?
only up to bronchi
Selective alpha 1 (increases SVR)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Medial part

11. What three factors effect total oxygen content of blood?
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)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Coagulation factors are made in the liver
8 (myc protein) with 2 - 14 - 22 (iG chains)

12. which nerve provides innervation for plantar flexion and inversion?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Tibial
11

13. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
ANCA because of lack of Ig and C3 deposits on IF
Nocardia
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

14. What does the severity of leprosy depend on?
Little effect on cell and no change
Barium enema
only up to bronchi
Strength of cell mediated immune response

15. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Raphe
RER; RER
In ER of bile canaliculi
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

16. 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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17. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
S. saprophyticus - and s. epidermidis; novobiocin
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Chorda tympani branch
Atrial

18. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Boiling - bleach - formalin - UV irradiation
Protamine sulfate
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Phencyclidine (PCP)

19. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
ATP binding (resets the myosin head to contract again for next binding)
Increase; decreased
Gluteus maximus; difficulty getting up from seated position and climbing chair
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

20. what clinical findings help distinguish small cell carcinoma?
Smoking
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Acute interstitial nephritis
200-500

21. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Covalent (between two cysteines)- allows protein to withstand denaturation
Biphosphonate
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

22. What is the mc malignancy in asbestosis?
Syringomelia
Apocrine; eccrine
Chlorpheniramine and diphenhydramine
Bronchogenic carcinoma

23. What three pathogens cause infectious esophagitis in HIV positive patients?
Hexokinase
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Classical conditioning
CMV - HSV 1 - Candida

24. What does extended consumption of appetite suppressants lead to?
Vagus (auricular branch); vasovagal syncope!
Pulmonary hypertension
SSRI
(urine PAH x urine flow rate)/plasma PAH

25. how does noise induced hearing loss occur?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Close but purkinje system to ensure contraction in a bottom up fashion
Trauma to stereociliated hair cells of the organ of corti

26. h1 receptor anatagonists are not effective in treatment of asthma only for...
Highly negative resting potential
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
chronic urticaria and allergic symptoms
Chorda tympani branch

27. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Highly negative resting potential
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Vascular endothelium; protease
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

28. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
GI tract; mood!
Fibrosis; macrophages
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Inhibits it

29. What is contraindicated in toxic mega colon?
Increase; decreased
Southern - western
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Hereditary angioedema; ACE inhibitors

30. why is crohns disease associated with oxaloacetate kidney stones?
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
Adductor
Tissue redistribution (out of plasma) rather than metabolism
HSV and VZV

31. other than proteinuria - What can cause foamy froathy urine?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Bile salt accumulation in urine
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste

32. What is the difference between paranoid personality disorder and delusional disorder?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
SS +rNA
Vertical diplopia
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

33. When is an S4 sound normal?
Measles and M3 AML`
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Well trained athletes and children
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

34. what kind of drug is sertraline? What is a common side effect?
46 - 4N; 23 2N
SSRI; erectile dysfunction
Increased reticulocytes
Bile salt accumulation in urine

35. what enzyme converts procarcinogens into carcinogens?
Downs; regurgitant AV valves - ASDs
P450 mitochondrial monooxygenase
Brief psychotic disorder; schizophreniform; schizophrenia
Anterior circumflex (and axillary nerve)

36. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No and yes
manifestations - congenital (stretching of periventricular pyrimadal fibers)
No (unlike adenomyosis); yes
frameshift mutations (missense is substitution)

37. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Inhibits it
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
only up to bronchi

38. What type of vision is myopia? In What type of patients does it improve?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

39. What are the three dopaminergic systems and What are they responsible for? disease?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Folic acid treatment!
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
hyponatremia (aldosterone activation equilibrates body volume)

40. 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?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Apocrine; eccrine
Acute gastric mucosal defects (superficial or full thickness)
CGD; t cell dysfxn (diGeorge)

41. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Aromatase deficiency in child
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

42. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Sydenham chorea
Phencyclidine (PCP)
C3 decreased after 5-10 days; sulfonamides
Dihydropyridine sensitive Ca channels (L type)

43. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
E. coli
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Downs; regurgitant AV valves - ASDs

44. What does the tuberoinfundibular pathway connect? What is it responsible for?
Common peroneal; bony fractures and compression; sciatic
ANCA because of lack of Ig and C3 deposits on IF
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Right heart failure

45. SIADH patients have normal blood volume but...
To pump calcium out in cardiac myocytes so that relaxation occurs
hyponatremia (aldosterone activation equilibrates body volume)
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

46. Where does lysyl oxidase act? What is the cofactor for that?
Drink plenty of fluids
On cardiac tissue and renal juxtaglomerular cells
In the extracellular space for collagen cross linking; zinc
Folic acid treatment!

47. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Folic acid treatment!
Serum FFA and serum triglyceride levels
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
SSRI

48. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Paramyxo and influenza
When it invades the bm; carcinoma in situ
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

49. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
200-500
Pulmonic and systemic!
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

50. What does protein M do in Group A strep<
Prevent phagocytosis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects