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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. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Anterior nares
S. saprophyticus - and s. epidermidis; novobiocin
transcription activation/suppression
Hypertension - edema - and proteinuria

2. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
No; yes

3. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Phencyclidine (PCP)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

4. What does hypocapnia cause in teh brain? What is hypocapnia?
No (unlike adenomyosis); yes
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Inhibits it
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)

5. What is Tzanck smear used to detect?
HSV and VZV
AV node slowest - to allow time for diastole
Excessive collagen formation during tissue repair in susceptible individuals
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

6. Which nerve lies in close proximity to the inferior thyroid artery?
Not lined by epithelium
Recurrent larygneal
RER; copper
No; yes

7. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
women
Pan colitis and right sided colitis (more than left sided and proctitis)

8. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
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)
No and yes
Medial part

9. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
46 - 4N; 23 2N
Folic acid treatment!
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

10. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Highly negative resting potential
On cardiac tissue and renal juxtaglomerular cells
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

11. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Normal; low
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Increase in permeability of two ions with equal and opposite equilibrium potentials

12. what defines hypoxemia?
No; MRI
RBC mass; epo levels (secondary has high)
SaO2 <92%
Anti centromere; anti DNA topoisomerase

13. What are the two coagulase negative staphylococci? How do you distinguish them?
S. aureus
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Folic acid treatment!
S. saprophyticus - and s. epidermidis; novobiocin

14. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hereditary angioedema; ACE inhibitors
Pulmonary hypertension

15. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
facultative intracellular
RER; RER
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)

16. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
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
Elevated GGT and macrocytosis
Curlings ulcers
Because of the low output from heart failure - they will have increased aldosterone levels

17. Acyl coA synthetase is not...
Proteasome inhibitor; treatment for MM and waldenstroms
Fibronectin - laminin - collagen
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
liver specific

18. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
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
Vertical diplopia
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

19. How do you calculate atributable risk percent?
Demargination of neutrophils from the vessel walls
RR-1/RR
Closer to head; closer to diaphragm
Nocardia

20. What is the primary histologic finding in patients with eczematous dermatitis?
No; yes
Increase; decreased
Aromatase deficiency in child
Spongiosis

21. which virus inactivates both Rb and p53?
Bronchial dilation (bronchiectasis)
Integration of viral DNA into genome of host hepatocytes
E6 and E7 of HPV knock off p53 and Rb suppressor genes
MAC complex (C5b - C9 complement deficiency)

22. what drug is useful for secretory diarrhea?
Initiation - pointing; pincer grasp; walking; mama/dada
Inhaled animal dander allergens
Octreotide
Little effect on cell and no change

23. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
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)
Joints d/t increased purine production and thus uric acid production
Medial circumflex artery; avascular necrosis
Neisseria induced small cell vasculitis (including hands and soles)

24. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Pulmonary hypertension
Acute gastric mucosal defects (superficial or full thickness)
Mean greater than median greater than mode
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

25. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Squatting - sitting - lying supine - passive leg raising
Amiloride - spironolactone - triamterene
Inhaled animal dander allergens

26. what happens to capacitance with age?
Insulin like growth factor 1 (just another name)
SVC and IVC; right below the aortic knob
...
Apocrine; eccrine

27. which nerve provides innervation for plantar flexion and inversion?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Tibial
S. aureus

28. What is cataplexy and When is it seen?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Both sides
P53 mutation; DCC is also required for adenoma to carcinoma

29. What is hypospadias caused by?
Abnormal closing of the urethral folds
Increased reticulocytes
TSh (in testicular tumors can cause hyperthyroidism)
Pan colitis and right sided colitis (more than left sided and proctitis)

30. What is capacitance inversely proportional to?
women
Decreases both
Elastance
Leukotriene precursor and does neutrophil chemotaxis

31. Metronidizaole does not cover...
In the extracellular space
gram positive organisms
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

32. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Closer to head; closer to diaphragm
Because gamma chains replace beta chains and then gamma chain formation wanes
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

33. which nucleus releases serotonin?
Raphe
Anterior nares
Coagulation factors are made in the liver
Integration of viral DNA into genome of host hepatocytes

34. carnitine deficiency impairs production of What and how?
Highly negative resting potential
Ketone body production by preventing fatty acids into the mitochondria
Superior larygeal; cricothyroid; recurrent laryngeal
OCPs - multiparity - breast feeding

35. on which chromosome is wilms tumor found?
11
Tzanck smear
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

36. 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)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
HSV ( also in utero: chlymadia - neisseria - group B strep)
Diabetic microangiopathy

37. a patient fearing all white coats is a phenomenon of what?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Cluster
Fibronectin - laminin - collagen
Classical conditioning

38. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Vagus (auricular branch); vasovagal syncope!
Superior larygeal; cricothyroid; recurrent laryngeal

39. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Tzanck smear
APP on chrom 21 (this is why downs more susceptible)
Hypo or hyper pigmentations; after tanning
Increase; decreased

40. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Turbulence
Hypertension - edema - and proteinuria
Selective alpha 1 (increases SVR)
women

41. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Acute interstitial nephritis
Decreases both
Vagus nerve stimulation

42. How do you treat gonococcal infection? chlymadia?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Ceftriaxone; azithromycin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Elevated GGT and macrocytosis

43. Where does conjugation of bilirubin take place?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
In ER of bile canaliculi
Congenital hypothyroidism - downs - amyloidosis - acromegaly
CMV - HSV 1 - Candida

44. 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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

45. name three pathological states that present with large tongues.
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly

46. what makes bruits?
Classical conditioning
P450 mitochondrial monooxygenase
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Turbulence

47. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Elevated GGT and macrocytosis
manifestations - congenital (stretching of periventricular pyrimadal fibers)

48. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Medial circumflex artery; avascular necrosis
Enterococci (e. faecalis)- found on genitalia area
As a CO2 carrier with the carboxylase enzyme

49. What does Rb protein do? what chrom is it on?
Headaches and facial flushing; vasodilation in meninges and skin
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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)
Because of the low output from heart failure - they will have increased aldosterone levels

50. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Cluster
Single adenomatous ones
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
11