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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. how can HAV be inactivated?
Closer to head; closer to diaphragm
Boiling - bleach - formalin - UV irradiation
Covalent (between two cysteines)- allows protein to withstand denaturation
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

2. how does achalasia present? What does barium swallow show on dilated esophagus?
Acute gastric mucosal defects (superficial or full thickness)
Retinitis; mononucleosis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Drug induced interstitial nephritis

3. 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?)?
transcription activation/suppression
T test; chi squared
Superior larygeal; cricothyroid; recurrent laryngeal
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

4. the rate of blood flow of which two circulations must equal each other at all times?
When it invades the bm; carcinoma in situ
Pulmonic and systemic!
Trauma to stereociliated hair cells of the organ of corti
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

5. how much percent of sodium is excreted? urea? glucose?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
transcription activation/suppression
<1% - 55% - concentration dependent
Susceptible; soluble (unable to be cultured in bile)

6. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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7. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Superior larygeal; cricothyroid; recurrent laryngeal
No and yes
Valproate

8. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Turbulence
MAO inhibitors; wine and cheese
To pump calcium out in cardiac myocytes so that relaxation occurs

9. What is medullary sponge kidney disease and how does it present? What does it lead to?
Classical conditioning
low in serum
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)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

10. why is crohns disease associated with oxaloacetate kidney stones?
Become beta pleated and then form neurofibrillary tangle!
Syncope - angina - dyspnea (SAD)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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

11. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Radial nerve and deep brachial artery
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
HSV and VZV

12. What are some side effects seen in TCAs?
11
Tibial
Strength of cell mediated immune response
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

13. at three years of age What are social - fine motor - gross motor and language developments?
I is more benign and can present later in adulthood
Intussusception
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

14. what marker should be followed in a patient with cirrhosis?
Bile salt accumulation in urine
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Superior larygeal; cricothyroid; recurrent laryngeal
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

15. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
C3 decreased after 5-10 days; sulfonamides

16. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

17. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Lateral; RV; RA; LV
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Amiadarone
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

18. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Decreases both
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

19. Where does lysyl oxidase act? What is the cofactor for that?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
In the extracellular space for collagen cross linking; zinc
Varying; erythema nodosum is common
4 - 4 - 9

20. do Class IC agents prolong the QT interval?
low in serum
Vagus nerve stimulation
Terminal bronchioles; small bronchi
No

21. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Hereditary angioedema; ACE inhibitors
Turners`
By vascular permeability and vasodilation
OCPs - multiparity - breast feeding

22. Metronidizaole does not cover...
gram positive organisms
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Highly negative resting potential

23. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Reiter syndrome; B27
Chorda tympani branch
Neisseria induced small cell vasculitis (including hands and soles)
Brief psychotic disorder; schizophreniform; schizophrenia

24. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Medial circumflex artery; avascular necrosis
Normal; low
46 - 4N; 23 2N

25. what would be a sign of absence of cardiogenic pulm edem?
Turners`
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Bile soluble which means they are bile sensitive
Ig A deficiency

26. What are the first generation anti histamines?
Turbulence
Vascular endothelium; protease
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Chlorpheniramine and diphenhydramine

27. How can renal blood flow be calculated from RPF?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Prostate tumor and increased osteoclast activity
RBF= PAH clearance/(1- hematocrit)
Hyperkalemia; potassium sparing diuretics - potassium supplements

28. What three factors effect total oxygen content of blood?
Increased reticulocytes
Fat - fertile - forty - female
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Tzanck smear

29. in overweight individuals What is thought to contribute to insulin resistance?
46 - 4N; 23 2N
Chorda tympani branch
Closer to head; closer to diaphragm
Serum FFA and serum triglyceride levels

30. name three pathological states that present with large tongues.
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

31. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
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)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
HSV ( also in utero: chlymadia - neisseria - group B strep)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

32. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
CMV - HSV 1 - Candida
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
MAO inhibitors; wine and cheese

33. other than increasing HDL levels - what else does niacin do?
glycerol kinase
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
MAC complex (C5b - C9 complement deficiency)
Prevents hepatic VLDL production

34. What is the mainstay treatment for acute mania?
Localized dermatologic pain that persists for more than one month after zoster eruption
Regular insulin (Not fast acting - regular better)
In the extracellular space for collagen cross linking; zinc
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

35. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
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
Little effect on cell and no change
Hereditary angioedema; ACE inhibitors
Fibronectin - laminin - collagen

36. What are diastolic (lowest) pressures in aorta? LV?
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
Around 70 (normal measured diastolic pressures); 9--
Mean greater than median greater than mode
Both sides

37. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Primary
Class I
Underestimation of gestational age

38. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
No (unlike adenomyosis); yes
Increase; decreased

39. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
manifestations - congenital (stretching of periventricular pyrimadal fibers)

40. When is acid phosphatase elevated (Name two times)?
Proteasome inhibitor; treatment for MM and waldenstroms
Prostate tumor and increased osteoclast activity
The time interval between S2 and OS- the shorter the interval - the more intense
Classical conditioning

41. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Measles and M3 AML`
Spongiosis
Octreotide

42. which opponens muscle does ulnar innervate?
gram positive organisms
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
Adductor
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

43. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Ceftriaxone; azithromycin
By vascular permeability and vasodilation
Prevents hepatic VLDL production

44. What is the mc manifestation of CMV in HIV patient? immunocompetent?
S3 gallop; S2 to opening snap interval
In the extracellular space
Class I
Retinitis; mononucleosis

45. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
SSRI
Hypertension - edema - and proteinuria
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

46. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Anterior circumflex (and axillary nerve)
Close but purkinje system to ensure contraction in a bottom up fashion
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

47. What is the mutation type in thalassemias? what process is defective because of this?
Joints d/t increased purine production and thus uric acid production
Vancomycin
gram positive organisms
Nonsense; mRNA processing

48. What is the presentation of angioedema? Where is most commonly affected?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Classical conditioning
Vertical diplopia

49. what protein is increased in Crohns disease? What does it do?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
NF- KB; responsible for cytokine production
Intussusception
Insulin like growth factor 1 (just another name)

50. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Hypo or hyper pigmentations; after tanning
Initiation - pointing; pincer grasp; walking; mama/dada
I is more benign and can present later in adulthood

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USMLE Prep 2

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