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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. after a thrombus extraction - what serum enzyme shoots up and why?
gram positive organisms
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Serum creatine kinase; reperfusion injury causes necrosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

2. in the LV and aorta - What are the pressures?
transcription activation/suppression
Become beta pleated and then form neurofibrillary tangle!
I is more benign and can present later in adulthood
Normally close to systolic

3. What does TGF beta do? What produces it?
Fibrosis; macrophages
Single adenomatous ones
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

4. in overweight individuals What is thought to contribute to insulin resistance?
Gluteus medius and minimus; positive trendelenberg
G to T in p53; HCC
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Serum FFA and serum triglyceride levels

5. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Squatting - sitting - lying supine - passive leg raising
GI tract; mood!
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

6. What is the most important prognostic indicator in patients with malignant melanoma?
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
P450 mitochondrial monooxygenase
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Measure of depth invasion (vertical!)

7. What is gardeners mydriasis? How is it treated?
differentiate
gram positive organisms
RER; copper
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

8. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Neisseria induced small cell vasculitis (including hands and soles)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Localized dermatologic pain that persists for more than one month after zoster eruption

9. What is an abortive viral infection?
Acute interstitial nephritis
To pump calcium out in cardiac myocytes so that relaxation occurs
Prepatellar
Little effect on cell and no change

10. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
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)
Hypertension - edema - and proteinuria

11. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Measles and M3 AML`
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

12. how does eos release MBP to kill protozoa etc?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Standing suddenly from supine position; valsalva maneuver
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Chorda tympani branch

13. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Nocardia
Vertical diplopia
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Around 70 (normal measured diastolic pressures); 9--

14. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Tibial
E. coli; staphylococcus saprophyticus
ANCA because of lack of Ig and C3 deposits on IF

15. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Because of vasodiation to skeletal muscles
Ig A deficiency
Diabetic microangiopathy

16. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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17. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Ketone body production by preventing fatty acids into the mitochondria
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Increase; decreased
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

18. PDAs are often asymptomatic. How do you treat?
Right before diastole (filling begins)
liver specific
Extrinsic def; instrinsic def; platelet def
indomethacin

19. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Adeno
Nocardia
Closer to head; closer to diaphragm

20. there are mucus secreting cells in the bronchioles...
only up to bronchi
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
Folic acid treatment!
Regular insulin (Not fast acting - regular better)

21. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
RER; RER
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
P53 mutation; AD

22. do Class IC agents prolong the QT interval?
Sickle cell; G6PD
No
Extrinsic def; instrinsic def; platelet def
Regular insulin (Not fast acting - regular better)

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

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24. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
High potassium conductance and some sodium conductance
MAO inhibitors; wine and cheese
frameshift mutations (missense is substitution)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

25. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Bile soluble which means they are bile sensitive
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Syncope - angina - dyspnea (SAD)

26. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
IgE
Covalent (between two cysteines)- allows protein to withstand denaturation
Biphosphonate

27. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Hexokinase
Minimal change disease
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

28. What is the mcc of elevated AFP leves in pregnancy>
Close but purkinje system to ensure contraction in a bottom up fashion
AV node slowest - to allow time for diastole
Underestimation of gestational age
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

29. What is achalasia and how would this correlate on the esophageal mannometry?
Reticulocytes
Phencyclidine (PCP)
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
CMV - HSV 1 - Candida

30. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
AV node slowest - to allow time for diastole
Amiadarone
RER; copper

31. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Radial nerve damage
Become beta pleated and then form neurofibrillary tangle!
Medial part
Echinococcus granulosus; anaphylaxis

32. Is there edema in primary Conns? secondary hyperaldosteronism? why?
In the extracellular space
SS +rNA
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

33. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Little effect on cell and no change
When it invades the bm; carcinoma in situ
Right heart failure
Cluster

34. at four years of age - What are the social - fine motor - gross motor - and language developments?
No
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
11
Myasthenia gravis

35. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
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
The term used to describe decreased drug responsiveness with repeated administration
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

36. what happens to capacitance with age?
...
Brief psychotic disorder; schizophreniform; schizophrenia
Medullary
Increase lymphatic drainage!

37. other than increasing HDL levels - what else does niacin do?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
As a CO2 carrier with the carboxylase enzyme
Well
Prevents hepatic VLDL production

38. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Excessive collagen formation during tissue repair in susceptible individuals
liver specific
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

39. What antibiotic is best to treat alcoholic pulm infections? why?
Vertical diplopia
low in serum
Not lined by epithelium
Clindamycin; covers anaerobic oral flora and aerobic bacteria

40. What is the cause of rapid plasma decay of thiopental?
Enterococci (e. faecalis)- found on genitalia area
Tissue redistribution (out of plasma) rather than metabolism
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
On cardiac tissue and renal juxtaglomerular cells

41. How do you explain the selective proteinuria of loss to albumin only in MCD?
Minimal change disease
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normally close to systolic

42. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
SaO2 <92%
Relfex tachycardia; giving beta blockers
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. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Syringomelia
Inhaled animal dander allergens
Adeno

44. What does hypocapnia cause in teh brain? What is hypocapnia?
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)
Ceftriaxone; azithromycin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
only up to bronchi

45. What is capacitance inversely proportional to?
Elastance
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

46. What are the two mcc of focal brain lesions in HIV positive patients?
No (unlike adenomyosis); yes
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

47. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Acute interstitial nephritis
Fibrosis; macrophages
Varying; erythema nodosum is common

48. What is the mc manifestation of CMV in HIV patient? immunocompetent?
FGF and VEGF
Aromatase deficiency in child
Retinitis; mononucleosis
Pain reliever - reduces pain by locking substance P in the PNS

49. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
High potassium conductance and some sodium conductance
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
G to T in p53; HCC

50. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Single adenomatous ones
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Coagulation factors are made in the liver