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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.
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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. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Relfex tachycardia; giving beta blockers
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

2. 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?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Ketone body production by preventing fatty acids into the mitochondria
Cluster
Anti cholinergic effects of pupil dilation and lack of accomodation

3. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
INTRApartum Abs (ampicillin/penicillin)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
chronic urticaria and allergic symptoms

4. What is damaged in early syringomelia? later?
Southern - western
gram positive organisms
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

5. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
In the extracellular space
P53 mutation; AD
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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

6. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Adeno
Hypo or hyper pigmentations; after tanning
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

7. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Think Hb deformation diseases
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Prevents hepatic VLDL production

8. metabolism of 1 gram of protein produces How many calories? carb? fat?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Common peroneal; bony fractures and compression; sciatic
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
4 - 4 - 9

9. What does Rb protein do? what chrom is it on?
gram positive organisms
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

10. when do ghon complexes form - primary or secondary TB?
Primary
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Faulty positioning of the genital tubercle
differentiate

11. how does noise induced hearing loss occur?
Another type of aldosterone antagonist (like spironolactone)
Vancomycin; histamine mediated
Trauma to stereociliated hair cells of the organ of corti
Varying; erythema nodosum is common

12. prostaglandin synthesis keeps...
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Hexokinase
PDA open

13. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
(urine PAH x urine flow rate)/plasma PAH
Fat - fertile - forty - female
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

14. carnitine deficiency impairs production of What and how?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Curlings ulcers
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
Ketone body production by preventing fatty acids into the mitochondria

15. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Around 70 (normal measured diastolic pressures); 9--
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

16. What is somatomedin C?
Aromatase deficiency in child
Insulin like growth factor 1 (just another name)
Appetite suppressants
differentiate

17. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Rabies encephalitis from cave bats; rabies killed vaccines
Leukotriene precursor and does neutrophil chemotaxis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

18. 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?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Protamine sulfate

19. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
E. coli; staphylococcus saprophyticus
Nocardia
Because of vasodiation to skeletal muscles
Sickle cell; G6PD

20. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
SVC and IVC; right below the aortic knob
Reticulocytes
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Large stroke volumes with ventricular contraction; aortic regurg

21. how does neisseria cause a petechial rash?
In the extracellular space
Anterior circumflex (and axillary nerve)
Not lined by epithelium
Neisseria induced small cell vasculitis (including hands and soles)

22. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Amiloride - spironolactone - triamterene
Vascular endothelium; protease
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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

23. 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
GI tract; mood!
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Drug induced interstitial nephritis

24. What is the mutation type in thalassemias? what process is defective because of this?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Classical conditioning
Echinococcus granulosus; anaphylaxis
Nonsense; mRNA processing

25. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
frameshift mutations (missense is substitution)
Fat - fertile - forty - female

26. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Diabetic microangiopathy
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

27. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Elevated GGT and macrocytosis
Chlorpheniramine and diphenhydramine
Aromatase deficiency in child

28. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
differentiate
Common peroneal; bony fractures and compression; sciatic
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

29. What does sustained hand grip do to the C/V system?
RR-1/RR
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
MAC complex (C5b - C9 complement deficiency)
No; yes

30. what diseases can vit A be used to treat?
Selective alpha 1 (increases SVR)
Measles and M3 AML`
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

31. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
Trauma to stereociliated hair cells of the organ of corti
Folic acid treatment!
Because of the low output from heart failure - they will have increased aldosterone levels

32. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Appetite suppressants
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
The time interval between S2 and OS- the shorter the interval - the more intense
RER; RER

33. What does TGF beta do? What produces it?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Elastance
Amiadarone
Fibrosis; macrophages

34. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Sarcoid
Anti cholinergic effects of pupil dilation and lack of accomodation
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Lateral; RV; RA; LV

35. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Because gamma chains replace beta chains and then gamma chain formation wanes
Vascular endothelium; protease
transcription activation/suppression
Highly negative resting potential

36. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
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)
Purkinje system; AV node
Joints d/t increased purine production and thus uric acid production

37. other than increasing HDL levels - what else does niacin do?
Pan colitis and right sided colitis (more than left sided and proctitis)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
(urine PAH x urine flow rate)/plasma PAH
Prevents hepatic VLDL production

38. other than proteinuria - What can cause foamy froathy urine?
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
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)
Underestimation of gestational age
Bile salt accumulation in urine

39. Where is conduction in heart fastest? slowest?
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
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
No
Purkinje system; AV node

40. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Susceptible; soluble (unable to be cultured in bile)
G to T in p53; HCC
Chlorpheniramine and diphenhydramine

41. What is the most important prognostic indicator in patients with malignant melanoma?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
No; MRI
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
Measure of depth invasion (vertical!)

42. What can cause virilization of a mother during pregnancy?
Chlorpheniramine and diphenhydramine
Aromatase deficiency in child
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Hyperkalemia; potassium sparing diuretics - potassium supplements

43. 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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44. What are diastolic (lowest) pressures in aorta? LV?
Retinitis; mononucleosis
Chlorpheniramine and diphenhydramine
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Around 70 (normal measured diastolic pressures); 9--

45. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
SSRI; erectile dysfunction
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

46. What test would be best to determine if a gene is being transcribed? translated?
S3 gallop; S2 to opening snap interval
Southern - western
Fibrosis; macrophages
No; yes

47. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Common peroneal; bony fractures and compression; sciatic
Hydrogen bonds dictate alpha or beta structure
women
Hypothyroidism

48. at four years of age - What are the social - fine motor - gross motor - and language developments?
Class I
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

49. do Class IC agents prolong the QT interval?
S. aureus
No
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Become beta pleated and then form neurofibrillary tangle!

50. Metronidizaole does not cover...
PDA open
Amiadarone
Acute gastric mucosal defects (superficial or full thickness)
gram positive organisms