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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. 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!)
Protamine sulfate
Vagus nerve stimulation
Intussusception

2. What does TGF beta do? What produces it?
Fibrosis; macrophages
G to T in p53; HCC
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Syncope - angina - dyspnea (SAD)

3. Which is slower AV node or ventricular muscle?
Skin flushing and warmth; prostaglandins; give with aspirin
SVC and IVC; right below the aortic knob
AV node slowest - to allow time for diastole
SVT; increases vagal tone; rectus abdominis

4. What are examples of action that decrease venous return to the heart?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Highly negative resting potential
Standing suddenly from supine position; valsalva maneuver
Dissolved in plasma and attached to Hgb

5. how long is substance P? What does it do?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
11 aa polypeptide; pain NT in CNS and PNS
RBC mass; epo levels (secondary has high)
TCAs and prazosin

6. What are the three dopaminergic systems and What are they responsible for? disease?
Dihydropyridine sensitive Ca channels (L type)
8; 12
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

7. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Common peroneal; bony fractures and compression; sciatic
...

8. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Fibronectin - laminin - collagen
Trochlear nerve (IV); abducens nerve (VI)
11 aa polypeptide; pain NT in CNS and PNS

9. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Hypothyroidism
OCPs - multiparity - breast feeding

10. what happens with LDL receptor density in statin therapy?
Enterococci (e. faecalis)- found on genitalia area
Increases
Superior larygeal; cricothyroid; recurrent laryngeal
Prepatellar

11. 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
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

12. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
As a CO2 carrier with the carboxylase enzyme
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Cluster

13. What are diastolic (lowest) pressures in aorta? LV?
Localized dermatologic pain that persists for more than one month after zoster eruption
Around 70 (normal measured diastolic pressures); 9--
Increased reticulocytes
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

14. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Ceftriaxone; azithromycin
P53 mutation; DCC is also required for adenoma to carcinoma
Increase in permeability of two ions with equal and opposite equilibrium potentials

15. What can long term leg cast wearing cause?
Trauma to stereociliated hair cells of the organ of corti
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

16. What does 'oxygen' content in blood refer to?
Both sides
Dissolved in plasma and attached to Hgb
Neisseria induced small cell vasculitis (including hands and soles)
Reticulocytes

17. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
II; I (I more abundant)
Become beta pleated and then form neurofibrillary tangle!
V fib; v. failure

18. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Mean greater than median greater than mode
TCAs and prazosin
Closer to head; closer to diaphragm
Medial part

19. nucleotide deletions do not cause missense mutations - they cause...
Spongiosis
Closer to head; closer to diaphragm
frameshift mutations (missense is substitution)
Joints d/t increased purine production and thus uric acid production

20. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
hyponatremia (aldosterone activation equilibrates body volume)
Excessive collagen formation during tissue repair in susceptible individuals
11

21. What is the mc location of brain germinomas?What are the classic symptoms?
Trauma to stereociliated hair cells of the organ of corti
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Drink plenty of fluids
Serum creatine kinase; reperfusion injury causes necrosis

22. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Enterococci (e. faecalis)- found on genitalia area
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

23. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
Coagulation factors are made in the liver
ZDV or AZT
Vagus (auricular branch); vasovagal syncope!

24. Where is conduction in heart fastest? slowest?
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)
Localized dermatologic pain that persists for more than one month after zoster eruption
Purkinje system; AV node
Gluteus maximus; difficulty getting up from seated position and climbing chair

25. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
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
SVC and IVC; right below the aortic knob
Bile salt accumulation in urine
Brief psychotic disorder; schizophreniform; schizophrenia

26. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Vascular endothelium; protease
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Inhaled animal dander allergens

27. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Ketone body production by preventing fatty acids into the mitochondria
Superior larygeal; cricothyroid; recurrent laryngeal
Fat - fertile - forty - female
indomethacin

28. carnitine deficiency impairs production of What and how?
Nocardia
G to T in p53; HCC
Ketone body production by preventing fatty acids into the mitochondria
Phencyclidine (PCP)

29. What is the cause of fixed splitting of S2? why?
CGD; t cell dysfxn (diGeorge)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Vancomycin
Little effect on cell and no change

30. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Anti cholinergic effects of pupil dilation and lack of accomodation
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
P450 mitochondrial monooxygenase

31. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
TCAs and prazosin
Pulmonic and systemic!
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Turners`

32. What does prolonged PT indicated? aPTT? bleeding time?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Extrinsic def; instrinsic def; platelet def
Diabetic microangiopathy
P53 mutation; AD

33. which cells produce surfactant? which ones mediate gas exchange?
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
II; I (I more abundant)
Duration and extent of disease
Well trained athletes and children

34. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
In the extracellular space for collagen cross linking; zinc
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
Vancomycin

35. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
RBF= PAH clearance/(1- hematocrit)
Increases
Congenital hypothyroidism - downs - amyloidosis - acromegaly

36. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
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
Anterior circumflex (and axillary nerve)
...

37. What can cause virilization of a mother during pregnancy?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Aromatase deficiency in child
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

38. other than in pyelonephritis - where else are WBC casts seen?
Covalent (between two cysteines)- allows protein to withstand denaturation
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Acute interstitial nephritis
GI malignancies and Insulin resistance (acromegal for ex)

39. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Skin flushing and warmth; prostaglandins; give with aspirin
Integration of viral DNA into genome of host hepatocytes
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Gluteus maximus; difficulty getting up from seated position and climbing chair

40. What is the presentation of angioedema? Where is most commonly affected?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Sydenham chorea
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
C3 decreased after 5-10 days; sulfonamides

41. What is the sole neurologic manifestation of acute rheumatic fever?
Cluster
Sydenham chorea
Apocrine; eccrine
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

42. What are some of the permissive effects of cortisol?
Pulmonary hypertension
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Well
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

43. What are the two growth factors associated with angiogenesis?
Another type of aldosterone antagonist (like spironolactone)
FGF and VEGF
E. coli
P53 mutation; AD

44. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Amiadarone
P53 mutation; DCC is also required for adenoma to carcinoma
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Retinitis; mononucleosis

45. What type of vision is myopia? In What type of patients does it improve?
Demargination of neutrophils from the vessel walls
Around 70 (normal measured diastolic pressures); 9--
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

46. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Highly negative resting potential
FGF and VEGF
Susceptible; soluble (unable to be cultured in bile)
Folic acid treatment!

47. are there signs of inflammation in avascular necrosis? then How do you diagnose?
SVC and IVC; right below the aortic knob
No; MRI
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

48. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Anterior nares
SVT; increases vagal tone; rectus abdominis
differentiate
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

49. what diseases can vit A be used to treat?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Measles and M3 AML`
Turners`
Bronchogenic carcinoma

50. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Inactivates kallikrein which activates kininogen into bradykinin
Octreotide
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage