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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 organ would an activating mutation in PRPP synthetase effect?
Increase by 50% in urine osmolality
Hypothyroidism
Joints d/t increased purine production and thus uric acid production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

2. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Env genes (for getting into target cells)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

3. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Little effect on cell and no change
Coagulation factors are made in the liver
Extrinsic def; instrinsic def; platelet def
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

4. What is the most common neurologic complication of VZV reactivation?
Ether and other organic solvents
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
Localized dermatologic pain that persists for more than one month after zoster eruption
Dihydropyridine sensitive Ca channels (L type)

5. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Sydenham chorea
Normal; low
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)

6. what commonly happens in GI in response to acute physiologic stress?
Increase; decreased
Another type of aldosterone antagonist (like spironolactone)
Acute gastric mucosal defects (superficial or full thickness)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

7. What is the mc location for avascular necrosis? What is it associated with?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hexokinase
Kallmans

8. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
In ER of bile canaliculi
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Selective alpha 1 (increases SVR)

9. What is the Na/Ca exchange used for?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Recurrent larygneal
Pan colitis and right sided colitis (more than left sided and proctitis)
To pump calcium out in cardiac myocytes so that relaxation occurs

10. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Chlorpheniramine and diphenhydramine
Standing suddenly from supine position; valsalva maneuver
Phencyclidine (PCP)

11. What does nitroprusside do to afterload? preload?
Acute gastric mucosal defects (superficial or full thickness)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Decreases both
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

12. Which is slower AV node or ventricular muscle?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
MAC complex (C5b - C9 complement deficiency)
Medial part
AV node slowest - to allow time for diastole

13. 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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14. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

15. neisseria are...
Duration and extent of disease
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Turners`
facultative intracellular

16. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Gluteus maximus; difficulty getting up from seated position and climbing chair
Normally close to systolic
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

17. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
In the extracellular space

18. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
glycerol kinase
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

19. What is epispadias caused by?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
NF- KB; responsible for cytokine production
Faulty positioning of the genital tubercle
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

20. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

21. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Tzanck smear
Vagus nerve stimulation
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
Think Hb deformation diseases

22. What can cause aortic regurg? What is the heart sound you hear?
Extrinsic def; instrinsic def; platelet def
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

23. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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24. What is a cell surface marker seen in liver angiosarcoma?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Reiter syndrome; B27
Cluster

25. What antibodies are present in CREST? What is the most specific?
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)
Right heart failure
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Anti centromere; anti DNA topoisomerase

26. 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?
FGF and VEGF
Gluteus maximus; difficulty getting up from seated position and climbing chair
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

27. What is an abortive viral infection?
As a CO2 carrier with the carboxylase enzyme
GI malignancies and Insulin resistance (acromegal for ex)
INTRApartum Abs (ampicillin/penicillin)
Little effect on cell and no change

28. what diseases can vit A be used to treat?
Measles and M3 AML`
Protamine sulfate
Biphosphonate
LT (LTD4 - E4 - C4) - and Ach

29. a patient fearing all white coats is a phenomenon of what?
Around 70 (normal measured diastolic pressures); 9--
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Classical conditioning

30. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Ig A deficiency
RER; copper

31. How do you treat gonococcal infection? chlymadia?
Hydrogen bonds dictate alpha or beta structure
Trochlear nerve (IV); abducens nerve (VI)
Ceftriaxone; azithromycin
Proteasome inhibitor; treatment for MM and waldenstroms

32. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Medial part
Protamine sulfate

33. how does neisseria cause a petechial rash?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Neisseria induced small cell vasculitis (including hands and soles)
Varying; erythema nodosum is common
Ig A deficiency

34. What does sustained hand grip do to the C/V system?
E. coli
Octreotide
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

35. What is difference between Arnold Chiari type I and II?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Ig A deficiency
Medullary
I is more benign and can present later in adulthood

36. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
indomethacin
Thymic tumor
differentiate
By vascular permeability and vasodilation

37. what induces bronchial squamous metaplasia?
Pan colitis and right sided colitis (more than left sided and proctitis)
Smoking
Underestimation of gestational age
APP on chrom 21 (this is why downs more susceptible)

38. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
SaO2 <92%
Because gamma chains replace beta chains and then gamma chain formation wanes
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

39. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
low in serum
Leukotriene precursor and does neutrophil chemotaxis
Octreotide

40. Acyl coA synthetase is not...
No; yes
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
liver specific

41. there are mucus secreting cells in the bronchioles...
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
Duration and extent of disease
Faulty positioning of the genital tubercle
only up to bronchi

42. what dissolves the lipid bilayer of a viral envelope?
To pump calcium out in cardiac myocytes so that relaxation occurs
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
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
Ether and other organic solvents

43. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Chorda tympani branch
Neisseria induced small cell vasculitis (including hands and soles)
Pulmonary hypertension
Rabies encephalitis from cave bats; rabies killed vaccines

44. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Trauma to stereociliated hair cells of the organ of corti
E. coli; staphylococcus saprophyticus
Both sides

45. other than increasing HDL levels - what else does niacin do?
CMV - HSV 1 - Candida
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Prevents hepatic VLDL production

46. in the LV and aorta - What are the pressures?
Anterior nares
Normally close to systolic
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Close but purkinje system to ensure contraction in a bottom up fashion

47. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Turbulence
Enterococci (e. faecalis)- found on genitalia area

48. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
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
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
IgE

49. What is the most common location of colonization of all s. aureus types?
Sydenham chorea
Gluteus medius and minimus; positive trendelenberg
Anterior nares
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

50. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Reiter syndrome; B27
Nonsense; mRNA processing
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)