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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. other than mycobacterim wha other bacteria is acid fast?
Nocardia
E. coli; staphylococcus saprophyticus
Close but purkinje system to ensure contraction in a bottom up fashion
Lateral; RV; RA; LV

2. What do you treat s. epidermidis with?
Become beta pleated and then form neurofibrillary tangle!
E. coli
Vancomycin
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

3. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
S. aureus
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

4. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Not lined by epithelium
Because of the low output from heart failure - they will have increased aldosterone levels
glycerol kinase

5. what immune deficiency causes recurrent neisseria infections?
(urine PAH x urine flow rate)/plasma PAH
Increases
ANCA because of lack of Ig and C3 deposits on IF
MAC complex (C5b - C9 complement deficiency)

6. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Vancomycin
C3 decreased after 5-10 days; sulfonamides
RER; RER
women

7. other than in pyelonephritis - where else are WBC casts seen?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Acute interstitial nephritis
Amiadarone
Chlorpheniramine and diphenhydramine

8. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Neisseria induced small cell vasculitis (including hands and soles)
Little effect on cell and no change
Joints d/t increased purine production and thus uric acid production

9. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Vertical diplopia
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

10. what dissolves the lipid bilayer of a viral envelope?
E. coli
gram positive organisms
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Ether and other organic solvents

11. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
glycerol kinase
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
RER; copper
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

12. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Inhaled animal dander allergens
Anterior nares
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

13. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Sarcoid

14. Acyl coA synthetase is not...
Squatting - sitting - lying supine - passive leg raising
RER; RER
Thymic tumor
liver specific

15. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Boiling - bleach - formalin - UV irradiation
Adductor

16. What are examples of action that decrease venous return to the heart?
Localized dermatologic pain that persists for more than one month after zoster eruption
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Standing suddenly from supine position; valsalva maneuver

17. other than parvo B19 - what else is associated with red cell aplasia?
Highly negative resting potential
Thymic tumor
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Rabies encephalitis from cave bats; rabies killed vaccines

18. the rate of blood flow of which two circulations must equal each other at all times?
Fibrosis; macrophages
Squatting - sitting - lying supine - passive leg raising
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Pulmonic and systemic!

19. What is the mc location of brain germinomas?What are the classic symptoms?
Raphe
AV node slowest - to allow time for diastole
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
No (unlike adenomyosis); yes

20. which are the only glycosylated proteins in HIV virus?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Gluteus medius and minimus; positive trendelenberg
Env genes (for getting into target cells)
Measles and M3 AML`

21. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
In the extracellular space for collagen cross linking; zinc
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
Vancomycin; histamine mediated
Intussusception

22. Which is faster purkinje system or atrial muscle?
Serum FFA and serum triglyceride levels
Close but purkinje system to ensure contraction in a bottom up fashion
By vascular permeability and vasodilation
NF- KB; responsible for cytokine production

23. What is intussusception? how does ischemia and necrosis occur?
Serum creatine kinase; reperfusion injury causes necrosis
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
Vancomycin; histamine mediated
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis

24. What is the cause of fixed splitting of S2? why?
E. coli
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Hereditary angioedema; ACE inhibitors
Env genes (for getting into target cells)

25. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
In ER of bile canaliculi
Bronchial dilation (bronchiectasis)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

26. What actions increase venous return?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
S. saprophyticus - and s. epidermidis; novobiocin
Squatting - sitting - lying supine - passive leg raising

27. What is the mutation type in thalassemias? what process is defective because of this?
indomethacin
Nonsense; mRNA processing
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
V fib; v. failure

28. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
S. aureus
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

29. How is dobutamine better than dopamine?
Ig A deficiency
Env genes (for getting into target cells)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

30. What are the primary determinants of colon cancer risk in UC patients
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Excessive collagen formation during tissue repair in susceptible individuals
Duration and extent of disease
Fibrosis; macrophages

31. How do bradykinin - C3a and C5a cause edema?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Abnormal closing of the urethral folds
C3 decreased after 5-10 days; sulfonamides
By vascular permeability and vasodilation

32. what defines hypoxemia?
LT (LTD4 - E4 - C4) - and Ach
Smoking
Highly negative resting potential
SaO2 <92%

33. What is achalasia and how would this correlate on the esophageal mannometry?
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
Reiter syndrome; B27
TSh (in testicular tumors can cause hyperthyroidism)
Hexokinase

34. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Ketone body production by preventing fatty acids into the mitochondria
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Rabies encephalitis from cave bats; rabies killed vaccines

35. if there are keratin swirls does that mean well or poorly differentiated?
Pain reliever - reduces pain by locking substance P in the PNS
Well
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Selective alpha 1 (increases SVR)

36. What is mcc of death pre hospital phase of MI? in hospital phase?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
V fib; v. failure
No and yes
Nonsense; mRNA processing

37. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
facultative intracellular
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Leukotriene precursor and does neutrophil chemotaxis

38. How do you treat gonococcal infection? chlymadia?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Relfex tachycardia; giving beta blockers
Ceftriaxone; azithromycin

39. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
SSRI; erectile dysfunction
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Terminal bronchioles; small bronchi

40. there are mucus secreting cells in the bronchioles...
Become beta pleated and then form neurofibrillary tangle!
Pulmonary hypertension
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
only up to bronchi

41. What does NF- KB do?
C3 decreased after 5-10 days; sulfonamides
Increases cytokine production
Ceftriaxone; azithromycin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

42. hypertonicity and hyperreflexity are ________________ of hydrocephalus
SVT; increases vagal tone; rectus abdominis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Increase lymphatic drainage!
low in serum

43. what diseases can vit A be used to treat?
Measles and M3 AML`
Barium enema
Covalent (between two cysteines)- allows protein to withstand denaturation
APP on chrom 21 (this is why downs more susceptible)

44. What is a primary HSV 1 infection like?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Because gamma chains replace beta chains and then gamma chain formation wanes
RER; copper
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

45. in the LV and aorta - What are the pressures?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
gram positive organisms
Normally close to systolic
Hereditary angioedema; ACE inhibitors

46. which antiarrythmic is associated with blue gray discoloration ?
Syncope - angina - dyspnea (SAD)
Amiadarone
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

47. What is the most common neurologic complication of VZV reactivation?
Increase by 50% in urine osmolality
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Localized dermatologic pain that persists for more than one month after zoster eruption

48. what commonly happens in GI in response to acute physiologic stress?
Bronchial dilation (bronchiectasis)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Acute gastric mucosal defects (superficial or full thickness)
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis

49. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Appetite suppressants
Gluteus maximus; difficulty getting up from seated position and climbing chair
Turners`
II; I (I more abundant)

50. What is Bortezomib and What is it used for?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
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
AV node slowest - to allow time for diastole
Proteasome inhibitor; treatment for MM and waldenstroms