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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. do Class IC agents prolong the QT interval?
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
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
TSh (in testicular tumors can cause hyperthyroidism)

2. within the right atrium - What is the maximum pressure? left atrium?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
8; 12
Well
Acute interstitial nephritis

3. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
RER; RER
S. aureus
Boiling - bleach - formalin - UV irradiation
CMV - HSV 1 - Candida

4. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Classical conditioning
Purkinje system; AV node
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Retinitis; mononucleosis

5. What type of endocarditis is cytoscopy induced?
Curlings ulcers
Skin flushing and warmth; prostaglandins; give with aspirin
Enterococci (e. faecalis)- found on genitalia area
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

6. what vessel would a fracture to the neck of the of the humerus damage?
INTRApartum Abs (ampicillin/penicillin)
Fat - fertile - forty - female
Anterior circumflex (and axillary nerve)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

7. What is used to treat heparin toxicity?
Pan colitis and right sided colitis (more than left sided and proctitis)
Acute gastric mucosal defects (superficial or full thickness)
RER; copper
Protamine sulfate

8. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
As a CO2 carrier with the carboxylase enzyme
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Measles and M3 AML`

9. on What part of the clavicle does the SCM attach?
Fibronectin - laminin - collagen
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Medial part
Valproate

10. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
liver specific
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
TCAs and prazosin
Both sides

11. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
differentiate
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
P53 mutation; DCC is also required for adenoma to carcinoma
Aromatase deficiency in child

12. is Rifampin ever used as monotherapY? why either way?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
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
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Highly negative resting potential

13. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Highly negative resting potential
Cluster
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

14. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Anti centromere; anti DNA topoisomerase
Adductor
Terminal bronchioles; small bronchi
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

15. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
women
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
facultative intracellular

16. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Trauma to stereociliated hair cells of the organ of corti
Regular insulin (Not fast acting - regular better)
Medial part

17. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Chorda tympani branch
By vascular permeability and vasodilation
Tissue redistribution (out of plasma) rather than metabolism

18. What translocations can cause c - myc overexpression?
Bronchial dilation (bronchiectasis)
Initiation - pointing; pincer grasp; walking; mama/dada
8 (myc protein) with 2 - 14 - 22 (iG chains)
GI malignancies and Insulin resistance (acromegal for ex)

19. What is intussusception? how does ischemia and necrosis occur?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Extrinsic def; instrinsic def; platelet def
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

20. what happens with LDL receptor density in statin therapy?
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
RER; RER
Cluster

21. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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

22. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
8 (myc protein) with 2 - 14 - 22 (iG chains)
women
Thymic tumor

23. What is the precursor protein to beta amyloid and On what chromosome is it found?
RER; RER
Anti - apoptotic (prevents going into apoptosis)- 18; 14
APP on chrom 21 (this is why downs more susceptible)
E. coli

24. non ceruloplasmin deposition - ceruloplasmin is...
Fat - fertile - forty - female
low in serum
Demargination of neutrophils from the vessel walls
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

25. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
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
No (unlike adenomyosis); yes
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
SVT; increases vagal tone; rectus abdominis

26. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Vagus nerve stimulation
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
HSV ( also in utero: chlymadia - neisseria - group B strep)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

27. What type of mutation does aflatoxin cause? what cancer does this increase for?
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
Prostate tumor and increased osteoclast activity
G to T in p53; HCC
Bile soluble which means they are bile sensitive

28. What would a deflection of the membrane potential to near zero indicate?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Increase in permeability of two ions with equal and opposite equilibrium potentials
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

29. What is the cause of rapid plasma decay of thiopental?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Think Hb deformation diseases
Tissue redistribution (out of plasma) rather than metabolism

30. What is the mutation type in thalassemias? what process is defective because of this?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Nonsense; mRNA processing
Increase lymphatic drainage!
T test; chi squared

31. What antibodies are present in CREST? What is the most specific?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Anti centromere; anti DNA topoisomerase
Hypothyroidism
Trauma to stereociliated hair cells of the organ of corti

32. What is a keloid?
In the extracellular space
Hyperkalemia; potassium sparing diuretics - potassium supplements
Excessive collagen formation during tissue repair in susceptible individuals
Reticulocytes

33. Would alpha 1 agonists cause flushing? muscarinic antagonist?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Atrial
No; yes

34. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
S3 gallop; S2 to opening snap interval
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Gluteus maximus; difficulty getting up from seated position and climbing chair
Duration and extent of disease

35. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Increases
Amiadarone
Proteasome inhibitor; treatment for MM and waldenstroms

36. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Initiation - pointing; pincer grasp; walking; mama/dada
Hereditary angioedema; ACE inhibitors
ZDV or AZT
On cardiac tissue and renal juxtaglomerular cells

37. How can renal blood flow be calculated from RPF?
Not lined by epithelium
RBF= PAH clearance/(1- hematocrit)
Octreotide
Increase; decreased

38. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Trauma to stereociliated hair cells of the organ of corti
Demargination of neutrophils from the vessel walls
ATP binding (resets the myosin head to contract again for next binding)

39. there are mucus secreting cells in the bronchioles...
Turners`
High potassium conductance and some sodium conductance
SVT; increases vagal tone; rectus abdominis
only up to bronchi

40. what drugs causes the red man syndrome? how does it occur?
Vertical diplopia
Vancomycin; histamine mediated
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RER; copper

41. What does TGF beta do? What produces it?
In ER of bile canaliculi
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Fibrosis; macrophages

42. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Fibronectin - laminin - collagen
SSRI
HSV ( also in utero: chlymadia - neisseria - group B strep)

43. 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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44. which antiarrythmic is associated with blue gray discoloration ?
Reiter syndrome; B27
Multiple miscarriages d/t hypercoaguability
Amiadarone
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

45. What are pancreatic pseudocysts called pseudo rather than true cysts?
ANCA because of lack of Ig and C3 deposits on IF
Ketone body production by preventing fatty acids into the mitochondria
Not lined by epithelium
Adductor

46. What is the Na/Ca exchange used for?
Little effect on cell and no change
Vancomycin; histamine mediated
To pump calcium out in cardiac myocytes so that relaxation occurs
Varying; erythema nodosum is common

47. What actions increase venous return?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Squatting - sitting - lying supine - passive leg raising
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

48. what diseases can vit A be used to treat?
DIC; TTP- HUS dont bleed that much
P53 mutation; AD
200-500
Measles and M3 AML`

49. what hormone is structurally similar to hCG?
Raphe
TSh (in testicular tumors can cause hyperthyroidism)
Increases
Hereditary angioedema; ACE inhibitors

50. why is crohns disease associated with oxaloacetate kidney stones?
No; MRI
indomethacin
Drug induced interstitial nephritis
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