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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 drugs causes the red man syndrome? how does it occur?
Proteasome inhibitor; treatment for MM and waldenstroms
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Vancomycin; histamine mediated

2. What is subacute sclerosisng encephalitis caused by?
Bronchial dilation (bronchiectasis)
Hexokinase
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
Myasthenia gravis

3. What is omalizumab and What is it used for?
RBC mass; epo levels (secondary has high)
Increases
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
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

4. what dictates the resting membrane potential of most cells?
Biphosphonate
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
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)
High potassium conductance and some sodium conductance

5. What is congestive hepatomegaly specific for?
Vertical diplopia
Right heart failure
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

6. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
SaO2 <92%
200-500
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

7. what hormone is structurally similar to hCG?
Tissue redistribution (out of plasma) rather than metabolism
TSh (in testicular tumors can cause hyperthyroidism)
C3 decreased after 5-10 days; sulfonamides
Relfex tachycardia; giving beta blockers

8. what diseases can vit A be used to treat?
ANCA because of lack of Ig and C3 deposits on IF
Measles and M3 AML`
Diabetic microangiopathy
Superior larygeal; cricothyroid; recurrent laryngeal

9. 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
Valproate
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
ANCA because of lack of Ig and C3 deposits on IF

10. What are the first generation anti histamines?
Vertical diplopia
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Chlorpheniramine and diphenhydramine

11. which are the only glycosylated proteins in HIV virus?
25; 25
Env genes (for getting into target cells)
Relfex tachycardia; giving beta blockers
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)

12. What triggers the neoplastic changes that are associated with HBV infecton?
Acute interstitial nephritis
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Phencyclidine (PCP)
Integration of viral DNA into genome of host hepatocytes

13. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Vancomycin; histamine mediated
Ether and other organic solvents
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
AV node slowest - to allow time for diastole

14. What can cause virilization of a mother during pregnancy?
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)
Aromatase deficiency in child
P450 mitochondrial monooxygenase
Serum creatine kinase; reperfusion injury causes necrosis

15. What effects does cortisol have on catecholamines?
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
Rabies encephalitis from cave bats; rabies killed vaccines
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
T test; chi squared

16. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Raphe
Chrom 8
SSRI; erectile dysfunction
Terminal bronchioles; small bronchi

17. in overweight individuals What is thought to contribute to insulin resistance?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
FGF and VEGF
Serum FFA and serum triglyceride levels
indomethacin

18. Metronidizaole does not cover...
Aromatase deficiency in child
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
gram positive organisms

19. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Chrom 8
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
11
Because of vasodiation to skeletal muscles

20. within the right atrium - What is the maximum pressure? left atrium?
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)
Purkinje system; AV node
8; 12
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

21. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hereditary angioedema; ACE inhibitors
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

22. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Pan colitis and right sided colitis (more than left sided and proctitis)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Abnormal closing of the urethral folds
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

23. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Phencyclidine (PCP)
SS +rNA
HSV ( also in utero: chlymadia - neisseria - group B strep)

24. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
GI tract; mood!

25. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
G to T in p53; HCC
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

26. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
PDA open
Prevents hepatic VLDL production
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

27. What type of mutation does aflatoxin cause? what cancer does this increase for?
Increase by 50% in urine osmolality
Sudden loss of muscle tone without loss of consciousness; narcolepsy
G to T in p53; HCC
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

28. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Regular insulin (Not fast acting - regular better)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

29. What antibodies are present in CREST? What is the most specific?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Right before diastole (filling begins)
Ig A deficiency
Anti centromere; anti DNA topoisomerase

30. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Boiling - bleach - formalin - UV irradiation
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Inhaled animal dander allergens

31. carnitine deficiency impairs production of What and how?
Lateral; RV; RA; LV
Ketone body production by preventing fatty acids into the mitochondria
Adductor
Apocrine; eccrine

32. SIADH patients have normal blood volume but...
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
hyponatremia (aldosterone activation equilibrates body volume)
Enterococci (e. faecalis)- found on genitalia area
Elastance

33. What translocations can cause c - myc overexpression?
V fib; v. failure
8 (myc protein) with 2 - 14 - 22 (iG chains)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Classical conditioning

34. What type of calcium channels dictate the plateau in cardiac myocyte?
Another type of aldosterone antagonist (like spironolactone)
AV node slowest - to allow time for diastole
Dihydropyridine sensitive Ca channels (L type)
E. coli

35. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Diabetic microangiopathy
Increased reticulocytes
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

36. What does the tuberoinfundibular pathway connect? What is it responsible for?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
ANCA because of lack of Ig and C3 deposits on IF
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex

37. what protects the resting heart from arrhythmias?
Highly negative resting potential
Vertical diplopia
25; 25
Multiple miscarriages d/t hypercoaguability

38. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Acute interstitial nephritis
Kallmans
Dissolved in plasma and attached to Hgb
RER; RER

39. on which chromosome is wilms tumor found?
Atrial
Another type of aldosterone antagonist (like spironolactone)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
11

40. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Measure of depth invasion (vertical!)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

41. What can long term leg cast wearing cause?
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
By vascular permeability and vasodilation
Increase by 50% in urine osmolality
Ketone body production by preventing fatty acids into the mitochondria

42. What is the mcc of elevated AFP leves in pregnancy>
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Ceftriaxone; azithromycin
Underestimation of gestational age

43. Acyl coA synthetase is not...
Leukotriene precursor and does neutrophil chemotaxis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
liver specific
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

44. which nerve provides innervation for plantar flexion and inversion?
SVC and IVC; right below the aortic knob
The time interval between S2 and OS- the shorter the interval - the more intense
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Tibial

45. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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
No; yes
DIC; TTP- HUS dont bleed that much
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)

46. When is acid phosphatase elevated (Name two times)?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Increase by 50% in urine osmolality
Prostate tumor and increased osteoclast activity
Myasthenia gravis

47. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Syringomelia
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

48. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Right before diastole (filling begins)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

49. What is a cell surface marker seen in liver angiosarcoma?
Decreases both
RR-1/RR
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

50. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Varying; erythema nodosum is common
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin