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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. If a patient has higher levels of HbF - What does this mean?
Proteasome inhibitor; treatment for MM and waldenstroms
hyponatremia (aldosterone activation equilibrates body volume)
II; I (I more abundant)
Think Hb deformation diseases

2. What can cause virilization of a mother during pregnancy?
OCPs - multiparity - breast feeding
Aromatase deficiency in child
Chlorpheniramine and diphenhydramine
Increases

3. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Valproate
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
TCAs and prazosin

4. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Lateral; RV; RA; LV
C3 decreased after 5-10 days; sulfonamides

5. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
AV node slowest - to allow time for diastole
HSV and VZV
Underestimation of gestational age

6. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Vancomycin
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
By vascular permeability and vasodilation

7. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
SVT; increases vagal tone; rectus abdominis
P53 mutation; DCC is also required for adenoma to carcinoma
Abnormal closing of the urethral folds
Echinococcus granulosus; anaphylaxis

8. What type of disease has selective proteinuria? What is found in urine? What is not?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
4 - 4 - 9
Clindamycin; covers anaerobic oral flora and aerobic bacteria

9. Where does terminal peptide cleavage of collagen fibrils take place?
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
Downs; regurgitant AV valves - ASDs
Fibronectin - laminin - collagen
In the extracellular space

10. How do you calculate RPF from urine PAH?
chronic urticaria and allergic symptoms
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Bile salt accumulation in urine
(urine PAH x urine flow rate)/plasma PAH

11. 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?
Duration and extent of disease
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Adductor
Myasthenia gravis

12. Where is aromatase used?
RR-1/RR
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
(urine PAH x urine flow rate)/plasma PAH
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

13. within the right atrium - What is the maximum pressure? left atrium?
Barium enema
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
8; 12
Normal; low

14. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Elevated GGT and macrocytosis
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)
In the extracellular space
Kallmans

15. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
RR-1/RR
Become beta pleated and then form neurofibrillary tangle!
Folic acid treatment!
Smoking

16. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Radial nerve and deep brachial artery
Strength of cell mediated immune response
By vascular permeability and vasodilation

17. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Syringomelia
E. coli; staphylococcus saprophyticus
P53 mutation; DCC is also required for adenoma to carcinoma
No; yes

18. What are some side effects seen in TCAs?
Inhibits it
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

19. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Lateral; RV; RA; LV
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
Measles and M3 AML`
Hypo or hyper pigmentations; after tanning

20. how much percent of sodium is excreted? urea? glucose?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Large stroke volumes with ventricular contraction; aortic regurg
Prepatellar
<1% - 55% - concentration dependent

21. what chromosome is c - myc found on?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Chrom 8
By vascular permeability and vasodilation
Primary

22. why does liver dysfunction cause coagulation disorders?
Skin flushing and warmth; prostaglandins; give with aspirin
Adeno
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Coagulation factors are made in the liver

23. what happens with LDL receptor density in statin therapy?
Increases
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Smoking
Relfex tachycardia; giving beta blockers

24. on which chromosome is wilms tumor found?
Measure of depth invasion (vertical!)
11
E6 and E7 of HPV knock off p53 and Rb suppressor genes
manifestations - congenital (stretching of periventricular pyrimadal fibers)

25. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
Right heart failure

26. What does prolonged PT indicated? aPTT? bleeding time?
IgE
Extrinsic def; instrinsic def; platelet def
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
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

27. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Strength of cell mediated immune response
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Right before diastole (filling begins)

28. What is used to prevent vertical transmission of HIV?
Drug induced interstitial nephritis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Amiloride - spironolactone - triamterene
ZDV or AZT

29. What type of endocarditis is cytoscopy induced?
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)
P53 mutation; DCC is also required for adenoma to carcinoma
Enterococci (e. faecalis)- found on genitalia area
Single adenomatous ones

30. what clinical findings help distinguish small cell carcinoma?
No; MRI
Standing suddenly from supine position; valsalva maneuver
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
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

31. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Increases cytokine production
V fib; v. failure

32. 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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33. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Protamine sulfate
Dissolved in plasma and attached to Hgb

34. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
AV node slowest - to allow time for diastole
Terminal bronchioles; small bronchi
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

35. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Regular insulin (Not fast acting - regular better)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Medial circumflex artery; avascular necrosis

36. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Right heart failure
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

37. What is a common complication of acute pancreatitis? What is it?
women
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
4 - 4 - 9

38. Acyl coA synthetase is not...
Serum creatine kinase; reperfusion injury causes necrosis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
liver specific
Folic acid treatment!

39. How can renal blood flow be calculated from RPF?
Intussusception
RBF= PAH clearance/(1- hematocrit)
P450 mitochondrial monooxygenase
Duration and extent of disease

40. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Adeno
46 - 4N; 23 2N
Chrom 8
Vagus nerve stimulation

41. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
SSRI
Fibrosis; macrophages
Because of vasodiation to skeletal muscles
Gluteus maximus; difficulty getting up from seated position and climbing chair

42. What is the difference between paranoid personality disorder and delusional disorder?
ANCA because of lack of Ig and C3 deposits on IF
I is more benign and can present later in adulthood
II; I (I more abundant)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

43. What type of mutation does aflatoxin cause? what cancer does this increase for?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Prostate tumor and increased osteoclast activity
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
G to T in p53; HCC

44. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Tzanck smear
Large stroke volumes with ventricular contraction; aortic regurg
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

45. after a thrombus extraction - what serum enzyme shoots up and why?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Selective alpha 1 (increases SVR)
Serum creatine kinase; reperfusion injury causes necrosis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

46. What is suggestive of complete central DI?
Relfex tachycardia; giving beta blockers
Increase by 50% in urine osmolality
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
AV node slowest - to allow time for diastole

47. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
Bile salt accumulation in urine
TSh (in testicular tumors can cause hyperthyroidism)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

48. What are the two mcc of focal brain lesions in HIV positive patients?
Dihydropyridine sensitive Ca channels (L type)
By vascular permeability and vasodilation
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

49. what immune deficiency causes recurrent neisseria infections?
Curlings ulcers
Excessive collagen formation during tissue repair in susceptible individuals
MAC complex (C5b - C9 complement deficiency)
Hypertension - edema - and proteinuria

50. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Another type of aldosterone antagonist (like spironolactone)
CGD; t cell dysfxn (diGeorge)
Diabetic microangiopathy
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours