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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. 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?
Pulmonary hypertension
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)
indomethacin
Superior larygeal; cricothyroid; recurrent laryngeal

2. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Classical conditioning
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Radial nerve and deep brachial artery

3. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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

4. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Demargination of neutrophils from the vessel walls
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
Curlings ulcers
P53 mutation; AD

5. what happens to capacitance with age?
Serum FFA and serum triglyceride levels
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
...
Enterococci (e. faecalis)- found on genitalia area

6. Where is the base of the heart? apex?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Class I
Closer to head; closer to diaphragm
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

7. What is medullary sponge kidney disease and how does it present? What does it lead to?
CMV - HSV 1 - Candida
Syringomelia
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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)

8. What are two common side effects of both acute and long acting nitrates? What causes them?
Reticulocytes
Headaches and facial flushing; vasodilation in meninges and skin
Medial part
Duration and extent of disease

9. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Inhibits it
G to T in p53; HCC
As a CO2 carrier with the carboxylase enzyme

10. what happens with LDL receptor density in statin therapy?
8; 12
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Increases

11. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Sickle cell; G6PD
Vancomycin
Well trained athletes and children

12. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Cluster
Relfex tachycardia; giving beta blockers
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
P53 mutation; DCC is also required for adenoma to carcinoma

13. What is damaged in early syringomelia? later?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Bile soluble which means they are bile sensitive
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

14. What does C1 esterase do other than inhibiting complement pathway?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Inactivates kallikrein which activates kininogen into bradykinin

15. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Hereditary angioedema; ACE inhibitors
Sydenham chorea
No and yes

16. do Class IC agents prolong the QT interval?
Localized dermatologic pain that persists for more than one month after zoster eruption
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
No
SSRI

17. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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
Decreases both
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

18. Where is aromatase used?
Neisseria induced small cell vasculitis (including hands and soles)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Circular - outside nucleus; transport proteins - rRNA - tRNA
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

19. why does liver dysfunction cause coagulation disorders?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Little effect on cell and no change
No; MRI
Coagulation factors are made in the liver

20. how much percent of sodium is excreted? urea? glucose?
No; yes
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
<1% - 55% - concentration dependent
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

21. What are the two mcc of focal brain lesions in HIV positive patients?
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Acute gastric mucosal defects (superficial or full thickness)
indomethacin

22. How do you calculate RPF from urine PAH?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Appetite suppressants
(urine PAH x urine flow rate)/plasma PAH

23. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Echinococcus granulosus; anaphylaxis
Because of vasodiation to skeletal muscles
Hypertension - edema - and proteinuria
II; I (I more abundant)

24. What is intussusception? how does ischemia and necrosis occur?
Dissolved in plasma and attached to Hgb
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Anti centromere; anti DNA topoisomerase
Amiadarone

25. What is subacute sclerosisng encephalitis caused by?
Large stroke volumes with ventricular contraction; aortic regurg
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Anti centromere; anti DNA topoisomerase
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

26. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Relfex tachycardia; giving beta blockers
Ceftriaxone; azithromycin

27. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
RR-1/RR
Because gamma chains replace beta chains and then gamma chain formation wanes
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
Phencyclidine (PCP)

28. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Think Hb deformation diseases
Measles and M3 AML`
Measure of depth invasion (vertical!)

29. What does nitroprusside do to afterload? preload?
S3 gallop; S2 to opening snap interval
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Decreases both
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

30. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
200-500
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Primary
Hypothyroidism

31. What is the precursor protein to beta amyloid and On what chromosome is it found?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Ig A deficiency
OCPs - multiparity - breast feeding
APP on chrom 21 (this is why downs more susceptible)

32. What is the triad seen in pre eclampsia?
IgE
Hypertension - edema - and proteinuria
Bile salt accumulation in urine
11

33. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Neisseria induced small cell vasculitis (including hands and soles)
low in serum

34. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
SSRI; erectile dysfunction
In the extracellular space

35. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Adductor
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)
Hydrogen bonds dictate alpha or beta structure
Mean greater than median greater than mode

36. prostaglandin synthesis keeps...
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Radial nerve damage
women
PDA open

37. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
...
Inactivates kallikrein which activates kininogen into bradykinin
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

38. in the LV and aorta - What are the pressures?
Normally close to systolic
Recurrent larygneal
TSh (in testicular tumors can cause hyperthyroidism)
Pan colitis and right sided colitis (more than left sided and proctitis)

39. what dictates the resting membrane potential of most cells?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Close but purkinje system to ensure contraction in a bottom up fashion
High potassium conductance and some sodium conductance
Turbulence

40. How do left sided colon adenocarcinomas present? right sided?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Integration of viral DNA into genome of host hepatocytes
Minimal change disease
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

41. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Increase; decreased
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
No and yes

42. What is gardeners mydriasis? How is it treated?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

43. What is an abortive viral infection?
RER; copper
P53 mutation; AD
Bronchial dilation (bronchiectasis)
Little effect on cell and no change

44. non ceruloplasmin deposition - ceruloplasmin is...
No; yes
I is more benign and can present later in adulthood
low in serum
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

45. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Measure of depth invasion (vertical!)
Amiadarone
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

46. What are the primary determinants of colon cancer risk in UC patients
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)
Duration and extent of disease
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Vagus nerve stimulation

47. What are fenfluramine - phentermine?
The term used to describe decreased drug responsiveness with repeated administration
Appetite suppressants
Enterococci (e. faecalis)- found on genitalia area
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

48. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Skin flushing and warmth; prostaglandins; give with aspirin

49. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
RER; RER
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Fibronectin - laminin - collagen

50. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Regular insulin (Not fast acting - regular better)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
differentiate
Reiter syndrome; B27

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USMLE Prep 2

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