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USMLE Prep 2

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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. in overweight individuals What is thought to contribute to insulin resistance?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Pain reliever - reduces pain by locking substance P in the PNS
Serum FFA and serum triglyceride levels
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

2. What is normal fibrinogen levels?
Around 70 (normal measured diastolic pressures); 9--
RR-1/RR
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
200-500

3. what locations of UC increase the risk of Colon cancer?
Sickle cell; G6PD
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Pan colitis and right sided colitis (more than left sided and proctitis)
25; 25

4. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Because gamma chains replace beta chains and then gamma chain formation wanes
Appetite suppressants

5. What is diagnostic (and possible therapeutic for intussusception)?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Increases cytokine production
Barium enema
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

6. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
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
Sydenham chorea
Inhibits it

7. What does L/S stand for in fetal lung maturity? When does maturity occur?
Serum creatine kinase; reperfusion injury causes necrosis
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Fibrosis; macrophages
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

8. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Congenital hypothyroidism - downs - amyloidosis - acromegaly
APP on chrom 21 (this is why downs more susceptible)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

9. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Turbulence
Hyperkalemia; potassium sparing diuretics - potassium supplements
E6 and E7 of HPV knock off p53 and Rb suppressor genes
differentiate

10. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Turbulence
11
Tibial
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

11. how long is substance P? What does it do?
Myasthenia gravis
11 aa polypeptide; pain NT in CNS and PNS
No (unlike adenomyosis); yes
Syringomelia

12. What is the mutation type in thalassemias? what process is defective because of this?
Phencyclidine (PCP)
Nonsense; mRNA processing
Nocardia
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

13. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Well trained athletes and children
Medial circumflex artery; avascular necrosis
The term used to describe decreased drug responsiveness with repeated administration
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

14. Where does conjugation of bilirubin take place?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
In ER of bile canaliculi
Serum creatine kinase; reperfusion injury causes necrosis
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

15. What type of drug is alendronate?
Vagus nerve stimulation
Well
APP on chrom 21 (this is why downs more susceptible)
Biphosphonate

16. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Squatting - sitting - lying supine - passive leg raising
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)
Intussusception
Echinococcus granulosus; anaphylaxis

17. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Spongiosis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Prepatellar

18. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Faulty positioning of the genital tubercle
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Elastance
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

19. What is extraocular muscle weakness a common symptom of?
Fat - fertile - forty - female
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Myasthenia gravis

20. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Minimal change disease
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

21. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Barium enema
CMV - HSV 1 - Candida
Little effect on cell and no change

22. What can chronic vit A toxicity cause?
hyponatremia (aldosterone activation equilibrates body volume)
Serum creatine kinase; reperfusion injury causes necrosis
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

23. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
No and yes
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
APP on chrom 21 (this is why downs more susceptible)

24. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
frameshift mutations (missense is substitution)
Octreotide
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Terminal bronchioles; small bronchi

25. What is the mcc of extrinsic allergic asthma?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
S3 gallop; S2 to opening snap interval
Inhaled animal dander allergens
Inactivates kallikrein which activates kininogen into bradykinin

26. what has the greatest effect on prognosis when treating c. diptheriae?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Sarcoid
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
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

27. What is subacute sclerosisng encephalitis caused by?
When it invades the bm; carcinoma in situ
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
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
Integration of viral DNA into genome of host hepatocytes

28. what diseases can vit A be used to treat?
Increase lymphatic drainage!
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
8 (myc protein) with 2 - 14 - 22 (iG chains)
Measles and M3 AML`

29. what nerve and artery course along the posterior aspect of the humerus?
S3 gallop; S2 to opening snap interval
Kallmans
Radial nerve and deep brachial artery
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

30. how does increased ICP result in curlings ulcers?
In the extracellular space
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Nonsense; mRNA processing
Vagus nerve stimulation

31. What does hypocapnia cause in teh brain? What is hypocapnia?
RBC mass; epo levels (secondary has high)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Bile salt accumulation in urine
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

32. What is the most common initital symptom of ADPKD? what else?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
T test; chi squared

33. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
High potassium conductance and some sodium conductance
CGD; t cell dysfxn (diGeorge)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
No

34. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Bile soluble which means they are bile sensitive
Common peroneal; bony fractures and compression; sciatic
Multiple miscarriages d/t hypercoaguability

35. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Measure of depth invasion (vertical!)
Syncope - angina - dyspnea (SAD)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Reiter syndrome; B27

36. what kind of drug is sertraline? What is a common side effect?
Radial nerve and deep brachial artery
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
SSRI; erectile dysfunction
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

37. What is tachyphylaxis?
In the extracellular space for collagen cross linking; zinc
The term used to describe decreased drug responsiveness with repeated administration
Nonsense; mRNA processing
Single adenomatous ones

38. What is damaged in early syringomelia? later?
Protamine sulfate
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
transcription activation/suppression

39. at three years of age What are social - fine motor - gross motor and language developments?
Because gamma chains replace beta chains and then gamma chain formation wanes
Smoking
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Raphe

40. prostaglandin synthesis keeps...
Regular insulin (Not fast acting - regular better)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
PDA open
GI tract; mood!

41. When is an S4 sound normal?
Biphosphonate
I is more benign and can present later in adulthood
Well trained athletes and children
Barium enema

42. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
low in serum
Bile soluble which means they are bile sensitive
INTRApartum Abs (ampicillin/penicillin)
Fibrosis; macrophages

43. What is the cause of fixed splitting of S2? why?
glycerol kinase
differentiate
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Hypertension - edema - and proteinuria

44. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Inactivates kallikrein which activates kininogen into bradykinin
Duration and extent of disease
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

45. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Inactivates kallikrein which activates kininogen into bradykinin
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
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
NF- KB; responsible for cytokine production

46. What is the presentation of angioedema? Where is most commonly affected?
RBF= PAH clearance/(1- hematocrit)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Vascular endothelium; protease
Not lined by epithelium

47. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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
Vertical diplopia
The term used to describe decreased drug responsiveness with repeated administration

48. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Vascular endothelium; protease

49. What are the three causes of acute MI in context of normal coronary arteries ?
Hydrogen bonds dictate alpha or beta structure
Close but purkinje system to ensure contraction in a bottom up fashion
Abnormal closing of the urethral folds
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

50. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Acute interstitial nephritis
SSRI
When it invades the bm; carcinoma in situ

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USMLE Prep 2

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