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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 are two indicators of chronic alcohol consumption?
Serum FFA and serum triglyceride levels
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Elevated GGT and macrocytosis
Fibrosis; macrophages

2. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Lateral; RV; RA; LV
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Bile soluble which means they are bile sensitive

3. what locations of UC increase the risk of Colon cancer?
Anterior nares
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
Pan colitis and right sided colitis (more than left sided and proctitis)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

4. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Covalent (between two cysteines)- allows protein to withstand denaturation
Circular - outside nucleus; transport proteins - rRNA - tRNA
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

5. other than increasing HDL levels - what else does niacin do?
Sarcoid
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Prevents hepatic VLDL production
Insulin like growth factor 1 (just another name)

6. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
II; I (I more abundant)
ZDV or AZT
Retinitis; mononucleosis

7. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
No; yes
ANCA because of lack of Ig and C3 deposits on IF
FGF and VEGF

8. What does protein M do in Group A strep<
Anterior nares
46 - 4N; 23 2N
Prevent phagocytosis
Brief psychotic disorder; schizophreniform; schizophrenia

9. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Serum creatine kinase; reperfusion injury causes necrosis
Hexokinase
Measure of depth invasion (vertical!)
No

10. what would be a sign of absence of cardiogenic pulm edem?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Chrom 8
Increase by 50% in urine osmolality

11. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Pain reliever - reduces pain by locking substance P in the PNS
Multiple miscarriages d/t hypercoaguability
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

12. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Measles and M3 AML`
S. saprophyticus - and s. epidermidis; novobiocin
Increase lymphatic drainage!
Intussusception

13. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
PDA open

14. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
gram positive organisms
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

15. What is the diagnosis in delayed puberty plus anosmia?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Intussusception
Tibial
Kallmans

16. What is achalasia and how would this correlate on the esophageal mannometry?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
When it invades the bm; carcinoma in situ
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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

17. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Reiter syndrome; B27
(urine PAH x urine flow rate)/plasma PAH
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
Fibrosis; macrophages

18. what vessel would a fracture to the neck of the of the humerus damage?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Anterior circumflex (and axillary nerve)
Sarcoid
Localized dermatologic pain that persists for more than one month after zoster eruption

19. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
P450 mitochondrial monooxygenase
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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
Extrinsic def; instrinsic def; platelet def

20. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
In the extracellular space for collagen cross linking; zinc
Downs; regurgitant AV valves - ASDs
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

21. What do you treat s. epidermidis with?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Vancomycin
ANCA because of lack of Ig and C3 deposits on IF

22. carnitine deficiency impairs production of What and how?
glycerol kinase
Ketone body production by preventing fatty acids into the mitochondria
Bile salt accumulation in urine
SS +rNA

23. Where does conjugation of bilirubin take place?
Ketone body production by preventing fatty acids into the mitochondria
In ER of bile canaliculi
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

24. What are diastolic (lowest) pressures in aorta? LV?
PDA open
Retinitis; mononucleosis
Around 70 (normal measured diastolic pressures); 9--
Leukotriene precursor and does neutrophil chemotaxis

25. What causes vertical diplopia? horizontal?
Extrinsic def; instrinsic def; platelet def
Sarcoid
Trochlear nerve (IV); abducens nerve (VI)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

26. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
No; MRI
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

27. What would a deflection of the membrane potential to near zero indicate?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Increase in permeability of two ions with equal and opposite equilibrium potentials
No (unlike adenomyosis); yes
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

28. why does neutrophila occur with corticosteroids?
Acute gastric mucosal defects (superficial or full thickness)
Demargination of neutrophils from the vessel walls
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

29. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Appetite suppressants
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Medullary
chronic urticaria and allergic symptoms

30. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Vertical diplopia
indomethacin
Single adenomatous ones

31. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
In ER of bile canaliculi
Protamine sulfate
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

32. how does neisseria cause a petechial rash?
SVT; increases vagal tone; rectus abdominis
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
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Neisseria induced small cell vasculitis (including hands and soles)

33. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Demargination of neutrophils from the vessel walls
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
HSV ( also in utero: chlymadia - neisseria - group B strep)
Selective alpha 1 (increases SVR)

34. How do you treat gonococcal infection? chlymadia?
SS +rNA
Increases
Brief psychotic disorder; schizophreniform; schizophrenia
Ceftriaxone; azithromycin

35. What is cataplexy and When is it seen?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
RER; RER

36. what indicates the severity of a mitral regurg ? mitral stenosis?
Biphosphonate
Chrom 8
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
S3 gallop; S2 to opening snap interval

37. What does nitroprusside do to afterload? preload?
As a CO2 carrier with the carboxylase enzyme
Decreases both
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
Bronchial dilation (bronchiectasis)

38. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Mean greater than median greater than mode
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Ketone body production by preventing fatty acids into the mitochondria
Rabies encephalitis from cave bats; rabies killed vaccines

39. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Ig A deficiency
Valproate
Anterior circumflex (and axillary nerve)
Appetite suppressants

40. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
The term used to describe decreased drug responsiveness with repeated administration
Bronchial dilation (bronchiectasis)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

41. What is pickwickian syndrome? What are the lab findings?
Neisseria induced small cell vasculitis (including hands and soles)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Vagus nerve stimulation
Normally close to systolic

42. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Increases cytokine production
Myasthenia gravis
Southern - western
Relfex tachycardia; giving beta blockers

43. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Trauma to stereociliated hair cells of the organ of corti
8; 12
frameshift mutations (missense is substitution)

44. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
AV node slowest - to allow time for diastole
Medial circumflex artery; avascular necrosis
P53 mutation; DCC is also required for adenoma to carcinoma
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

45. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Increase by 50% in urine osmolality
Right heart failure
Enterococci (e. faecalis)- found on genitalia area
Intussusception

46. what hormone is structurally similar to hCG?
Reticulocytes
RER; RER
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
TSh (in testicular tumors can cause hyperthyroidism)

47. prostaglandin synthesis keeps...
PDA open
frameshift mutations (missense is substitution)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Medial circumflex artery; avascular necrosis

48. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
APP on chrom 21 (this is why downs more susceptible)
Curlings ulcers
Drink plenty of fluids
Sydenham chorea

49. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Neisseria induced small cell vasculitis (including hands and soles)
E. coli; staphylococcus saprophyticus
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

50. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
TCAs and prazosin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Syncope - angina - dyspnea (SAD)