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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. what murmur is enhanced by decreased blood flow to the heart?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Not lined by epithelium
Both sides

2. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
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
SSRI
Reiter syndrome; B27
Hexokinase

3. What effects does cortisol have on catecholamines?
Sarcoid
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Vancomycin; histamine mediated
CGD; t cell dysfxn (diGeorge)

4. What does p53 do? what chrom is it on?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Close but purkinje system to ensure contraction in a bottom up fashion
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Relfex tachycardia; giving beta blockers

5. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
GI tract; mood!
Terminal bronchioles; small bronchi
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

6. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Paramyxo and influenza

7. What are the three predominant symptoms of VHL? What is its mode of inheritance?
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
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hypo or hyper pigmentations; after tanning
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

8. What are some of the permissive effects of cortisol?
SS +rNA
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
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Right before diastole (filling begins)

9. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
46 - 4N; 23 2N
Inhaled animal dander allergens

10. What does NF- KB do?
Syncope - angina - dyspnea (SAD)
Normally close to systolic
Increases cytokine production
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

11. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
glycerol kinase
MAC complex (C5b - C9 complement deficiency)
Sudden loss of muscle tone without loss of consciousness; narcolepsy

12. What is the mc manifestation of CMV in HIV patient? immunocompetent?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Class I
Retinitis; mononucleosis

13. what happens with LDL receptor density in statin therapy?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Increases
(urine PAH x urine flow rate)/plasma PAH

14. What is the preferred treatment for DKA?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Regular insulin (Not fast acting - regular better)
Prevent phagocytosis
Hereditary angioedema; ACE inhibitors

15. What can cause aortic regurg? What is the heart sound you hear?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Increase lymphatic drainage!
glycerol kinase
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

16. how much percent of sodium is excreted? urea? glucose?
Prevents hepatic VLDL production
<1% - 55% - concentration dependent
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

17. what diseases can vit A be used to treat?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Around 70 (normal measured diastolic pressures); 9--
Fibrosis; macrophages
Measles and M3 AML`

18. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Drink plenty of fluids
Turners`
GI malignancies and Insulin resistance (acromegal for ex)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

19. What is achalasia and how would this correlate on the esophageal mannometry?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Fibrosis; macrophages
Medial circumflex artery; avascular necrosis
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

20. how does achalasia present? What does barium swallow show on dilated esophagus?
Mean greater than median greater than mode
CMV - HSV 1 - Candida
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Medial part

21. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Purkinje system; AV node
Bile soluble which means they are bile sensitive
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

22. what clinical findings help distinguish small cell carcinoma?
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)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Terminal bronchioles; small bronchi

23. what should you think of in 'smear of an oral ulcer base'?
Multiple miscarriages d/t hypercoaguability
Tzanck smear
OCPs - multiparity - breast feeding
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)

24. how can HAV be inactivated?
Increase lymphatic drainage!
Boiling - bleach - formalin - UV irradiation
Increases
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

25. on What part of the clavicle does the SCM attach?
gram positive organisms
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Medial part
200-500

26. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Turners`
46 - 4N; 23 2N
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

27. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
S3 gallop; S2 to opening snap interval
(urine PAH x urine flow rate)/plasma PAH
HSV ( also in utero: chlymadia - neisseria - group B strep)
Anti cholinergic effects of pupil dilation and lack of accomodation

28. which opponens muscle does ulnar innervate?
The time interval between S2 and OS- the shorter the interval - the more intense
Adductor
Anti centromere; anti DNA topoisomerase
Anterior circumflex (and axillary nerve)

29. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Trochlear nerve (IV); abducens nerve (VI)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
LT (LTD4 - E4 - C4) - and Ach
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

30. What is epleronone?
Syringomelia
Another type of aldosterone antagonist (like spironolactone)
No
Fat - fertile - forty - female

31. what phase do adenosine and acetylcholine act on? doing what?
Hydrogen bonds dictate alpha or beta structure
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
No (unlike adenomyosis); yes

32. other than mycobacterim wha other bacteria is acid fast?
Anti centromere; anti DNA topoisomerase
Nocardia
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
OCPs - multiparity - breast feeding

33. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Class I
C3 decreased after 5-10 days; sulfonamides
Anterior circumflex (and axillary nerve)
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

34. What are the two coagulase negative staphylococci? How do you distinguish them?
Pulmonic and systemic!
Hypothyroidism
S. saprophyticus - and s. epidermidis; novobiocin
Cluster

35. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Demargination of neutrophils from the vessel walls
Acute gastric mucosal defects (superficial or full thickness)
Syncope - angina - dyspnea (SAD)

36. What does TGF beta do? What produces it?
liver specific
Fibrosis; macrophages
LT (LTD4 - E4 - C4) - and Ach
Vagus nerve stimulation

37. Acyl coA synthetase is not...
Inactivates kallikrein which activates kininogen into bradykinin
Adductor
Kallmans
liver specific

38. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Hereditary angioedema; ACE inhibitors
low in serum

39. What are two common side effects of both acute and long acting nitrates? What causes them?
Intussusception
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Prevent phagocytosis
Headaches and facial flushing; vasodilation in meninges and skin

40. What is difference between Arnold Chiari type I and II?
Relfex tachycardia; giving beta blockers
Acute gastric mucosal defects (superficial or full thickness)
I is more benign and can present later in adulthood
SVT; increases vagal tone; rectus abdominis

41. How do you calculate RPF from urine PAH?
11 aa polypeptide; pain NT in CNS and PNS
(urine PAH x urine flow rate)/plasma PAH
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

42. What are the first generation anti histamines?
S3 gallop; S2 to opening snap interval
Selective alpha 1 (increases SVR)
Pain reliever - reduces pain by locking substance P in the PNS
Chlorpheniramine and diphenhydramine

43. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
CGD; t cell dysfxn (diGeorge)
Faulty positioning of the genital tubercle
Closer to head; closer to diaphragm

44. which two virus families have hemagluttinin on their surface?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Paramyxo and influenza
Abnormal closing of the urethral folds
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

45. In What type of nephritis would you see high serum eos count?
Myasthenia gravis
Drug induced interstitial nephritis
Syncope - angina - dyspnea (SAD)
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

46. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Proteasome inhibitor; treatment for MM and waldenstroms
Normally close to systolic
Sarcoid
Lateral; RV; RA; LV

47. What causes wrist drop?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Radial nerve damage
When it invades the bm; carcinoma in situ
Increased reticulocytes

48. 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
Closer to head; closer to diaphragm
V fib; v. failure
Selective alpha 1 (increases SVR)

49. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
gram positive organisms
Syringomelia
Bile soluble which means they are bile sensitive

50. what would be a sign of absence of cardiogenic pulm edem?
I is more benign and can present later in adulthood
No (unlike adenomyosis); yes
Not lined by epithelium
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)