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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. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
TSh (in testicular tumors can cause hyperthyroidism)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Nonsense; mRNA processing

2. What causes wrist drop?
Medial circumflex artery; avascular necrosis
Radial nerve damage
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

3. What is normal fibrinogen levels?
200-500
Serum FFA and serum triglyceride levels
S3 gallop; S2 to opening snap interval
Cluster

4. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
11
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Hypo or hyper pigmentations; after tanning

5. What is capacitance inversely proportional to?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Elastance
Strength of cell mediated immune response
Duration and extent of disease

6. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Adeno
SVT; increases vagal tone; rectus abdominis
To pump calcium out in cardiac myocytes so that relaxation occurs

7. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Vagus (auricular branch); vasovagal syncope!
Hydrogen bonds dictate alpha or beta structure

8. What does VIP do to gastric acid secretion?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Inhibits it
Increase lymphatic drainage!
ATP binding (resets the myosin head to contract again for next binding)

9. 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?
SSRI
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Class I

10. 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?
frameshift mutations (missense is substitution)
46 - 4N; 23 2N
Congenital hypothyroidism - downs - amyloidosis - acromegaly
In the extracellular space for collagen cross linking; zinc

11. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
As a CO2 carrier with the carboxylase enzyme
I is more benign and can present later in adulthood
Proteasome inhibitor; treatment for MM and waldenstroms

12. What is epispadias caused by?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Faulty positioning of the genital tubercle
Highly negative resting potential
Increases cytokine production

13. What type of drug is alendronate?
4 - 4 - 9
chronic urticaria and allergic symptoms
Myasthenia gravis
Biphosphonate

14. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Increases
Retinitis; mononucleosis

15. What is the presentation of angioedema? Where is most commonly affected?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Gluteus medius and minimus; positive trendelenberg
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

16. what has the greatest effect on prognosis when treating c. diptheriae?
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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

17. PDAs are often asymptomatic. How do you treat?
indomethacin
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Abnormal closing of the urethral folds
Barium enema

18. on What part of the clavicle does the SCM attach?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Medial part
manifestations - congenital (stretching of periventricular pyrimadal fibers)

19. Where does complement bind on the Fc region of 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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Amiloride - spironolactone - triamterene
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

20. nucleotide deletions do not cause missense mutations - they cause...
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
No (unlike adenomyosis); yes
frameshift mutations (missense is substitution)

21. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Insulin like growth factor 1 (just another name)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

22. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Inactivates kallikrein which activates kininogen into bradykinin
Dissolved in plasma and attached to Hgb
Abnormal closing of the urethral folds

23. what virus causes pharyngoconjuctival fever?
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Adeno
Relfex tachycardia; giving beta blockers
Gluteus medius and minimus; positive trendelenberg

24. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Hypertension - edema - and proteinuria
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Bile salt accumulation in urine
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

25. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Radial nerve and deep brachial artery
Chorda tympani branch
IgE

26. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Sydenham chorea
SVT; increases vagal tone; rectus abdominis
RER; RER
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)

27. which two virus families have hemagluttinin on their surface?
Terminal bronchioles; small bronchi
Paramyxo and influenza
SSRI
I is more benign and can present later in adulthood

28. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Vancomycin
By vascular permeability and vasodilation
Gluteus medius and minimus; positive trendelenberg
Reiter syndrome; B27

29. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Hypothyroidism
Serum FFA and serum triglyceride levels
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Raphe

30. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
SS +rNA
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

31. in the LV and aorta - What are the pressures?
Normally close to systolic
Appetite suppressants
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Integration of viral DNA into genome of host hepatocytes

32. What are diastolic (lowest) pressures in aorta? LV?
Anti centromere; anti DNA topoisomerase
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Around 70 (normal measured diastolic pressures); 9--
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

33. What is used to prevent vertical transmission of HIV?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
ZDV or AZT
facultative intracellular
FGF and VEGF

34. What three factors effect total oxygen content of blood?
Medullary
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Boiling - bleach - formalin - UV irradiation
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

35. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Ether and other organic solvents
II; I (I more abundant)
Cluster

36. What pulmonary structural change can kartageners syndrome cause?
(urine PAH x urine flow rate)/plasma PAH
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
HSV ( also in utero: chlymadia - neisseria - group B strep)
Bronchial dilation (bronchiectasis)

37. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Normally close to systolic
Little effect on cell and no change
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

38. What causes vertical diplopia? horizontal?
Radial nerve damage
Pan colitis and right sided colitis (more than left sided and proctitis)
On cardiac tissue and renal juxtaglomerular cells
Trochlear nerve (IV); abducens nerve (VI)

39. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
SVC and IVC; right below the aortic knob
ANCA because of lack of Ig and C3 deposits on IF
Inactivates kallikrein which activates kininogen into bradykinin

40. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity

41. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Adeno
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
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

42. Acyl coA synthetase is not...
Pan colitis and right sided colitis (more than left sided and proctitis)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
liver specific

43. what chromosome is c - myc found on?
ATP binding (resets the myosin head to contract again for next binding)
Vancomycin; histamine mediated
Hexokinase
Chrom 8

44. 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?
Localized dermatologic pain that persists for more than one month after zoster eruption
Regular insulin (Not fast acting - regular better)
Squatting - sitting - lying supine - passive leg raising
Apocrine; eccrine

45. What does nitroprusside do to afterload? preload?
Appetite suppressants
On cardiac tissue and renal juxtaglomerular cells
Decreases both
Measure of depth invasion (vertical!)

46. What does C1 esterase do other than inhibiting complement pathway?
Prepatellar
chronic urticaria and allergic symptoms
Inactivates kallikrein which activates kininogen into bradykinin
Echinococcus granulosus; anaphylaxis

47. a patient fearing all white coats is a phenomenon of what?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
ANCA because of lack of Ig and C3 deposits on IF
Smoking
Classical conditioning

48. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
When it invades the bm; carcinoma in situ
P53 mutation; DCC is also required for adenoma to carcinoma
MAC complex (C5b - C9 complement deficiency)
<1% - 55% - concentration dependent

49. neisseria are...
Decreases both
Terminal bronchioles; small bronchi
facultative intracellular
ZDV or AZT

50. What are the two coagulase negative staphylococci? How do you distinguish them?
Echinococcus granulosus; anaphylaxis
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Cluster
S. saprophyticus - and s. epidermidis; novobiocin