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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 type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
To pump calcium out in cardiac myocytes so that relaxation occurs
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
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

2. What can long term leg cast wearing cause?
Prostate tumor and increased osteoclast activity
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
I is more benign and can present later in adulthood
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

3. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Chorda tympani branch
GI tract; mood!
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

4. What are the first generation anti histamines?
P450 mitochondrial monooxygenase
Increase lymphatic drainage!
Chlorpheniramine and diphenhydramine
Decreases both

5. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Turners`

6. What is a cell surface marker seen in liver angiosarcoma?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ig A deficiency
Bile soluble which means they are bile sensitive
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

7. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
4 - 4 - 9
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Hyperkalemia; potassium sparing diuretics - potassium supplements

8. What is achalasia and how would this correlate on the esophageal mannometry?
Amiloride - spironolactone - triamterene
SaO2 <92%
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
PDA open

9. what has the greatest effect on prognosis when treating c. diptheriae?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
In the extracellular space for collagen cross linking; zinc

10. What is normal fibrinogen levels?
Trauma to stereociliated hair cells of the organ of corti
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
200-500
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)

11. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Become beta pleated and then form neurofibrillary tangle!
Valproate
Fibronectin - laminin - collagen

12. What is the mcc of extrinsic allergic asthma?
No; yes
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
Inhaled animal dander allergens

13. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
GI tract; mood!
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

14. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Close but purkinje system to ensure contraction in a bottom up fashion
The time interval between S2 and OS- the shorter the interval - the more intense
Vascular endothelium; protease

15. Is there edema in primary Conns? secondary hyperaldosteronism? why?
facultative intracellular
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Vancomycin
Medial part

16. Which nerve lies in close proximity to the inferior thyroid artery?
Prevents hepatic VLDL production
Recurrent larygneal
Highly negative resting potential
P53 mutation; DCC is also required for adenoma to carcinoma

17. What pulmonary structural change can kartageners syndrome cause?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Increased reticulocytes
Bronchial dilation (bronchiectasis)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

18. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
ANCA because of lack of Ig and C3 deposits on IF
Decreases both
Coagulation factors are made in the liver
Increase; decreased

19. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
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
Turners`
gram positive organisms
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

20. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Octreotide
Normal; low
Hexokinase
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

21. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Duration and extent of disease
NF- KB; responsible for cytokine production
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

22. what marker should be followed in a patient with cirrhosis?
Medial part
Medullary
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

23. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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

24. What are examples of action that decrease venous return to the heart?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Standing suddenly from supine position; valsalva maneuver
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

25. which cells produce surfactant? which ones mediate gas exchange?
Little effect on cell and no change
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
Gluteus medius and minimus; positive trendelenberg
II; I (I more abundant)

26. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
As a CO2 carrier with the carboxylase enzyme
Tibial
Minimal change disease

27. what hormone is structurally similar to hCG?
Both sides
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
TSh (in testicular tumors can cause hyperthyroidism)
Well

28. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Extrinsic def; instrinsic def; platelet def
RER; copper
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

29. What can cause virilization of a mother during pregnancy?
Duration and extent of disease
Aromatase deficiency in child
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

30. 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?
Squatting - sitting - lying supine - passive leg raising
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Gluteus medius and minimus; positive trendelenberg
Common peroneal; bony fractures and compression; sciatic

31. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
manifestations - congenital (stretching of periventricular pyrimadal fibers)
E. coli; staphylococcus saprophyticus
Vertical diplopia

32. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Bronchogenic carcinoma
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
TCAs and prazosin

33. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Recurrent larygneal
Become beta pleated and then form neurofibrillary tangle!
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
HSV ( also in utero: chlymadia - neisseria - group B strep)

34. When does opening snap begin?
Right before diastole (filling begins)
liver specific
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Bronchial dilation (bronchiectasis)

35. What are some side effects seen in TCAs?
8; 12
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

36. prostaglandin synthesis keeps...
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
PDA open
frameshift mutations (missense is substitution)
DIC; TTP- HUS dont bleed that much

37. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Think Hb deformation diseases
Hyperkalemia; potassium sparing diuretics - potassium supplements
Vertical diplopia

38. at three years of age What are social - fine motor - gross motor and language developments?
Dihydropyridine sensitive Ca channels (L type)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Relfex tachycardia; giving beta blockers

39. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Adeno
I is more benign and can present later in adulthood
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

40. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
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
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Vagus (auricular branch); vasovagal syncope!

41. Where does 90% of serotonin lie? What is this NT responsible?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Prepatellar
Radial nerve damage
GI tract; mood!

42. What is the neurologic manifestation of ADPKD?
Appetite suppressants
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Pain reliever - reduces pain by locking substance P in the PNS

43. What is the precursor protein to beta amyloid and On what chromosome is it found?
S. saprophyticus - and s. epidermidis; novobiocin
LT (LTD4 - E4 - C4) - and Ach
4 - 4 - 9
APP on chrom 21 (this is why downs more susceptible)

44. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
S. saprophyticus - and s. epidermidis; novobiocin
Classical conditioning
Protamine sulfate

45. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
gram positive organisms
Amiloride - spironolactone - triamterene
Boiling - bleach - formalin - UV irradiation

46. How do you calculate atributable risk percent?
RR-1/RR
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Gluteus maximus; difficulty getting up from seated position and climbing chair

47. what commonly happens in GI in response to acute physiologic stress?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Multiple miscarriages d/t hypercoaguability
Elastance
Acute gastric mucosal defects (superficial or full thickness)

48. what dictates the resting membrane potential of most cells?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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)
High potassium conductance and some sodium conductance
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

49. a patient fearing all white coats is a phenomenon of what?
Purkinje system; AV node
Relfex tachycardia; giving beta blockers
Dihydropyridine sensitive Ca channels (L type)
Classical conditioning

50. What are the two mcc of focal brain lesions in HIV positive patients?
Pulmonic and systemic!
Elevated GGT and macrocytosis
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
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