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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. neisseria are...
Because of the low output from heart failure - they will have increased aldosterone levels
The time interval between S2 and OS- the shorter the interval - the more intense
facultative intracellular
To pump calcium out in cardiac myocytes so that relaxation occurs

2. What is used to compare means? categorical outcomes?
ZDV or AZT
Tissue redistribution (out of plasma) rather than metabolism
T test; chi squared
Hypertension - edema - and proteinuria

3. What is the primary histologic finding in patients with eczematous dermatitis?
Curlings ulcers
In the extracellular space for collagen cross linking; zinc
NF- KB; responsible for cytokine production
Spongiosis

4. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Vascular endothelium; protease
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Bile soluble which means they are bile sensitive

5. What translocations can cause c - myc overexpression?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Appetite suppressants
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

6. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Folic acid treatment!
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
chronic urticaria and allergic symptoms

7. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
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)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Medullary
Chorda tympani branch

8. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
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
Inactivates kallikrein which activates kininogen into bradykinin

9. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Pan colitis and right sided colitis (more than left sided and proctitis)
C3 decreased after 5-10 days; sulfonamides
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

10. What is the mcc of elevated AFP leves in pregnancy>
facultative intracellular
Underestimation of gestational age
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
HSV ( also in utero: chlymadia - neisseria - group B strep)

11. What is capsaicin? Where does it work?
Mean greater than median greater than mode
Pain reliever - reduces pain by locking substance P in the PNS
Downs; regurgitant AV valves - ASDs
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)

12. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
differentiate
TCAs and prazosin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

13. what happens to capacitance with age?
Trauma to stereociliated hair cells of the organ of corti
Selective alpha 1 (increases SVR)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
...

14. what makes bruits?
Chrom 8
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
ATP binding (resets the myosin head to contract again for next binding)
Turbulence

15. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Rabies encephalitis from cave bats; rabies killed vaccines
Radial nerve damage
Gluteus maximus; difficulty getting up from seated position and climbing chair
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)

16. in essential fructosuria - what enzyme do patients use to metabolize fructose?
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
low in serum
Hexokinase
Radial nerve and deep brachial artery

17. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Increase in permeability of two ions with equal and opposite equilibrium potentials
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

18. which opponens muscle does ulnar innervate?
Adductor
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Minimal change disease
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

19. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Vertical diplopia
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Increase in permeability of two ions with equal and opposite equilibrium potentials

20. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
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
Spongiosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
gram positive organisms

21. What is capacitance inversely proportional to?
LT (LTD4 - E4 - C4) - and Ach
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Elastance
P450 mitochondrial monooxygenase

22. 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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Vancomycin
Tzanck smear

23. which nerve provides innervation for plantar flexion and inversion?
Anterior nares
Tibial
Class I
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

24. What is the preferred treatment for DKA?
8 (myc protein) with 2 - 14 - 22 (iG chains)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Regular insulin (Not fast acting - regular better)

25. Would alpha 1 agonists cause flushing? muscarinic antagonist?
chronic urticaria and allergic symptoms
TCAs and prazosin
No; yes
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

26. What is the sole neurologic manifestation of acute rheumatic fever?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Sydenham chorea

27. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Bronchial dilation (bronchiectasis)
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)

28. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Radial nerve and deep brachial artery
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
No; MRI
Leukotriene precursor and does neutrophil chemotaxis

29. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
E. coli; staphylococcus saprophyticus
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

30. What is the stabilizing force for the secondary structure of proteins?
Dihydropyridine sensitive Ca channels (L type)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hydrogen bonds dictate alpha or beta structure
25; 25

31. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Downs; regurgitant AV valves - ASDs
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
GI malignancies and Insulin resistance (acromegal for ex)
<1% - 55% - concentration dependent

32. What are the acute effects of corticosteroids on the CBC?
By vascular permeability and vasodilation
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

33. in overweight individuals What is thought to contribute to insulin resistance?
Anterior nares
Serum FFA and serum triglyceride levels
Covalent (between two cysteines)- allows protein to withstand denaturation
Fibrosis; macrophages

34. What is cataplexy and When is it seen?
Ceftriaxone; azithromycin
Vascular endothelium; protease
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

35. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
No (unlike adenomyosis); yes
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

36. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Inhibits it
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
OCPs - multiparity - breast feeding

37. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
P450 mitochondrial monooxygenase
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Insulin like growth factor 1 (just another name)

38. Which is faster atrial muscle or ventricular muscle?
Think Hb deformation diseases
Atrial
Ig A deficiency
25; 25

39. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Apocrine; eccrine

40. What is suggestive of complete central DI?
Dissolved in plasma and attached to Hgb
Increase by 50% in urine osmolality
Extrinsic def; instrinsic def; platelet def
Increases bronchial and vascular smooth muscle reactivity to catecholamines

41. Where does 90% of serotonin lie? What is this NT responsible?
4 - 4 - 9
GI tract; mood!
Tibial
FGF and VEGF

42. when do ghon complexes form - primary or secondary TB?
Primary
liver specific
SaO2 <92%
Become beta pleated and then form neurofibrillary tangle!

43. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Faulty positioning of the genital tubercle
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

44. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Bile salt accumulation in urine
Phencyclidine (PCP)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Regular insulin (Not fast acting - regular better)

45. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
facultative intracellular
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
Initiation - pointing; pincer grasp; walking; mama/dada
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

46. When is an S4 sound normal?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Adductor
Well trained athletes and children

47. 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
Vancomycin; histamine mediated
Trauma to stereociliated hair cells of the organ of corti
By vascular permeability and vasodilation

48. how does neisseria cause a petechial rash?
Raphe
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Neisseria induced small cell vasculitis (including hands and soles)
Anterior circumflex (and axillary nerve)

49. where are the two classical places that the ulnar nerve can be injured?

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50. What can cause virilization of a mother during pregnancy?
Strength of cell mediated immune response
Aromatase deficiency in child
Right heart failure
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

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USMLE Prep 2

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