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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. What does sustained hand grip do to the C/V system?
MAC complex (C5b - C9 complement deficiency)
Downs; regurgitant AV valves - ASDs
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

2. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Chorda tympani branch

3. What are some side effects seen in TCAs?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
SS +rNA
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
11 aa polypeptide; pain NT in CNS and PNS

4. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Lateral; RV; RA; LV
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Multiple miscarriages d/t hypercoaguability

5. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Turners`

6. What is 5- HETE and What does it do?
Hydrogen bonds dictate alpha or beta structure
transcription activation/suppression
Valproate
Leukotriene precursor and does neutrophil chemotaxis

7. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
11 aa polypeptide; pain NT in CNS and PNS
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Minimal change disease

8. What agonists reduce the gradient across the LV outflow tract?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Serum creatine kinase; reperfusion injury causes necrosis
I is more benign and can present later in adulthood
Selective alpha 1 (increases SVR)

9. what hormone is structurally similar to hCG?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Drink plenty of fluids
TSh (in testicular tumors can cause hyperthyroidism)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

10. Which is faster purkinje system or atrial muscle?
G to T in p53; HCC
Pan colitis and right sided colitis (more than left sided and proctitis)
Close but purkinje system to ensure contraction in a bottom up fashion
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

11. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Anti cholinergic effects of pupil dilation and lack of accomodation
NF- KB; responsible for cytokine production
Initiation - pointing; pincer grasp; walking; mama/dada

12. When is acid phosphatase elevated (Name two times)?
On cardiac tissue and renal juxtaglomerular cells
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Prostate tumor and increased osteoclast activity
Closer to head; closer to diaphragm

13. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Tzanck smear
Bronchogenic carcinoma
TSh (in testicular tumors can cause hyperthyroidism)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

14. What is diagnostic (and possible therapeutic for intussusception)?
Fibronectin - laminin - collagen
Become beta pleated and then form neurofibrillary tangle!
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Barium enema

15. which nucleus releases serotonin?
Raphe
Tissue redistribution (out of plasma) rather than metabolism
...
Well trained athletes and children

16. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Well
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Ig A deficiency

17. What is the mc location of brain germinomas?What are the classic symptoms?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
APP on chrom 21 (this is why downs more susceptible)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

18. What are the primary determinants of colon cancer risk in UC patients
Pulmonary hypertension
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Duration and extent of disease
No (unlike adenomyosis); yes

19. within the right atrium - What is the maximum pressure? left atrium?
RBC mass; epo levels (secondary has high)
8; 12
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
8 (myc protein) with 2 - 14 - 22 (iG chains)

20. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Retinitis; mononucleosis

21. What is gardeners mydriasis? How is it treated?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

22. what has the greatest effect on prognosis when treating c. diptheriae?
ANCA because of lack of Ig and C3 deposits on IF
Reiter syndrome; B27
Hereditary angioedema; ACE inhibitors
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

23. which are the only glycosylated proteins in HIV virus?
Abnormal closing of the urethral folds
Reticulocytes
Mean greater than median greater than mode
Env genes (for getting into target cells)

24. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
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
ANCA because of lack of Ig and C3 deposits on IF
Because of the low output from heart failure - they will have increased aldosterone levels

25. 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?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Leukotriene precursor and does neutrophil chemotaxis
Lateral; RV; RA; LV
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

26. What are the three predominant symptoms of VHL? What is its mode of inheritance?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
IgE
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

27. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Inhaled animal dander allergens
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
APP on chrom 21 (this is why downs more susceptible)

28. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
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)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Abnormal closing of the urethral folds
Chlorpheniramine and diphenhydramine

29. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Reiter syndrome; B27

30. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Congenital hypothyroidism - downs - amyloidosis - acromegaly
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

31. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Bronchial dilation (bronchiectasis)
Because of the low output from heart failure - they will have increased aldosterone levels
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

32. What is somatomedin C?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
S. saprophyticus - and s. epidermidis; novobiocin
Recurrent larygneal
Insulin like growth factor 1 (just another name)

33. What is epispadias caused by?
S3 gallop; S2 to opening snap interval
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
ZDV or AZT
Faulty positioning of the genital tubercle

34. What are the acute effects of corticosteroids on the CBC?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Chorda tympani branch
Become beta pleated and then form neurofibrillary tangle!

35. Where does conjugation of bilirubin take place?
Drug induced interstitial nephritis
Close but purkinje system to ensure contraction in a bottom up fashion
When it invades the bm; carcinoma in situ
In ER of bile canaliculi

36. on which chromosome is wilms tumor found?
In the extracellular space
Duration and extent of disease
11
HSV and VZV

37. what protects the resting heart from arrhythmias?
GI tract; mood!
Highly negative resting potential
Anti cholinergic effects of pupil dilation and lack of accomodation
The time interval between S2 and OS- the shorter the interval - the more intense

38. how does noise induced hearing loss occur?
Think Hb deformation diseases
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Trauma to stereociliated hair cells of the organ of corti
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

39. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
SVT; increases vagal tone; rectus abdominis
Primary
E. coli; staphylococcus saprophyticus

40. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Increases cytokine production
Vagus nerve stimulation
II; I (I more abundant)
Reiter syndrome; B27

41. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Demargination of neutrophils from the vessel walls
TCAs and prazosin
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

42. What is congestive hepatomegaly specific for?
By vascular permeability and vasodilation
Right heart failure
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Nocardia

43. How do bradykinin - C3a and C5a cause edema?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
By vascular permeability and vasodilation
When it invades the bm; carcinoma in situ

44. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Trochlear nerve (IV); abducens nerve (VI)
transcription activation/suppression
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
P450 mitochondrial monooxygenase

45. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Strength of cell mediated immune response
Relfex tachycardia; giving beta blockers
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Increases

46. why does variocele occur more in left side?
Rabies encephalitis from cave bats; rabies killed vaccines
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Vancomycin

47. What are three symptoms in s.typhi?
Rabies encephalitis from cave bats; rabies killed vaccines
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Vagus nerve stimulation

48. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
ZDV or AZT
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

49. what bursa is affected when on knees like a maid/gardner?
(urine PAH x urine flow rate)/plasma PAH
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Bile salt accumulation in urine
Prepatellar

50. what vessel would a fracture to the neck of the of the humerus damage?
Increases cytokine production
Anterior circumflex (and axillary nerve)
Trochlear nerve (IV); abducens nerve (VI)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic