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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 does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
(urine PAH x urine flow rate)/plasma PAH
Syringomelia
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

2. What does VIP do to gastric acid secretion?
Inhibits it
Phencyclidine (PCP)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Env genes (for getting into target cells)

3. What is diagnostic (and possible therapeutic for intussusception)?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
facultative intracellular
Southern - western
Barium enema

4. What are the three dopaminergic systems and What are they responsible for? disease?
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Echinococcus granulosus; anaphylaxis
Increases cytokine production

5. on What part of the clavicle does the SCM attach?
Acute gastric mucosal defects (superficial or full thickness)
HSV and VZV
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Medial part

6. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
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
Trauma to stereociliated hair cells of the organ of corti
Mean greater than median greater than mode

7. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Medial circumflex artery; avascular necrosis
Vagus (auricular branch); vasovagal syncope!
8 (myc protein) with 2 - 14 - 22 (iG chains)

8. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
11
Large stroke volumes with ventricular contraction; aortic regurg
women
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

9. what nerve and artery course along the posterior aspect of the humerus?
Pulmonary hypertension
Hydrogen bonds dictate alpha or beta structure
Radial nerve and deep brachial artery
Gluteus medius and minimus; positive trendelenberg

10. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Nonsense; mRNA processing
Right before diastole (filling begins)

11. prostaglandin synthesis keeps...
PDA open
Strength of cell mediated immune response
Enterococci (e. faecalis)- found on genitalia area
Measles and M3 AML`

12. what enzyme converts procarcinogens into carcinogens?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
P450 mitochondrial monooxygenase
SSRI; erectile dysfunction
Susceptible; soluble (unable to be cultured in bile)

13. What are pancreatic pseudocysts called pseudo rather than true cysts?
Bronchial dilation (bronchiectasis)
4 - 4 - 9
Increased reticulocytes
Not lined by epithelium

14. what has the greatest effect on prognosis when treating c. diptheriae?
Brief psychotic disorder; schizophreniform; schizophrenia
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
AV node slowest - to allow time for diastole
Tzanck smear

15. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

16. What is the difference between additive and synergistic?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Prevents hepatic VLDL production
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
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

17. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
SVC and IVC; right below the aortic knob
P53 mutation; DCC is also required for adenoma to carcinoma
CMV - HSV 1 - Candida
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

18. What can cause aortic regurg? What is the heart sound you hear?
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
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
The term used to describe decreased drug responsiveness with repeated administration
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

19. If a patient has higher levels of HbF - What does this mean?
No; MRI
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Think Hb deformation diseases
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

20. What is the mutation type in thalassemias? what process is defective because of this?
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
Increase by 50% in urine osmolality
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Nonsense; mRNA processing

21. Where does conjugation of bilirubin take place?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
In ER of bile canaliculi
liver specific
Syringomelia

22. after a thrombus extraction - what serum enzyme shoots up and why?
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
facultative intracellular
Serum creatine kinase; reperfusion injury causes necrosis

23. what clinical findings help distinguish small cell carcinoma?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Common peroneal; bony fractures and compression; sciatic
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

24. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
No
Gluteus maximus; difficulty getting up from seated position and climbing chair
Sudden loss of muscle tone without loss of consciousness; narcolepsy

25. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
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
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Faulty positioning of the genital tubercle

26. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Sickle cell; G6PD
Protamine sulfate
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

27. what would be a sign of absence of cardiogenic pulm edem?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Another type of aldosterone antagonist (like spironolactone)

28. 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
Hereditary angioedema; ACE inhibitors
frameshift mutations (missense is substitution)
Serum creatine kinase; reperfusion injury causes necrosis

29. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Class I
Hypo or hyper pigmentations; after tanning
(urine PAH x urine flow rate)/plasma PAH
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

30. the rate of blood flow of which two circulations must equal each other at all times?
Hypertension - edema - and proteinuria
Pulmonic and systemic!
No (unlike adenomyosis); yes
SSRI

31. which has better side effect profile - SSRI or TCA?
SSRI
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Single adenomatous ones
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

32. What is the most common cause of pyelonephritis in both adults and childre?
Cluster
E. coli
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
liver specific

33. there are mucus secreting cells in the bronchioles...
only up to bronchi
<1% - 55% - concentration dependent
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hydrogen bonds dictate alpha or beta structure

34. which are the only glycosylated proteins in HIV virus?
Joints d/t increased purine production and thus uric acid production
Think Hb deformation diseases
Vagus nerve stimulation
Env genes (for getting into target cells)

35. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
11 aa polypeptide; pain NT in CNS and PNS
Myasthenia gravis

36. What is the stabilizing force for the secondary structure of proteins?
Highly negative resting potential
Another type of aldosterone antagonist (like spironolactone)
Hydrogen bonds dictate alpha or beta structure
No and yes

37. non ceruloplasmin deposition - ceruloplasmin is...
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Bile soluble which means they are bile sensitive
low in serum
Abnormal closing of the urethral folds

38. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Amiloride - spironolactone - triamterene
11 aa polypeptide; pain NT in CNS and PNS
Extrinsic def; instrinsic def; platelet def

39. what should you think of in 'smear of an oral ulcer base'?
Fat - fertile - forty - female
Tzanck smear
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Primary

40. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Retinitis; mononucleosis
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

41. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
OCPs - multiparity - breast feeding
Syringomelia
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
Thymic tumor

42. What does sustained hand grip do to the C/V system?
Vagus nerve stimulation
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Right heart failure
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

43. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Downs; regurgitant AV valves - ASDs
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

44. what induces bronchial squamous metaplasia?
Smoking
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
hyponatremia (aldosterone activation equilibrates body volume)
Hyperkalemia; potassium sparing diuretics - potassium supplements

45. What is the most common initital symptom of ADPKD? what else?
Highly negative resting potential
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RR-1/RR
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

46. what chromosome is c - myc found on?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Chrom 8
Hydrogen bonds dictate alpha or beta structure
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

47. what vessel would a fracture to the neck of the of the humerus damage?
8; 12
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Anterior circumflex (and axillary nerve)

48. why does neutrophila occur with corticosteroids?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Demargination of neutrophils from the vessel walls
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Inactivates kallikrein which activates kininogen into bradykinin

49. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
IgE
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

50. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Gluteus medius and minimus; positive trendelenberg
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria