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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. which staphylococci can do mannitol fermaentation?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Joints d/t increased purine production and thus uric acid production
S. aureus
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

2. 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
Because of the low output from heart failure - they will have increased aldosterone levels
Prevent phagocytosis
Increased reticulocytes

3. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
The time interval between S2 and OS- the shorter the interval - the more intense
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Valproate
Think Hb deformation diseases

4. What causes curlings ulcers?
Joints d/t increased purine production and thus uric acid production
women
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

5. What triggers the neoplastic changes that are associated with HBV infecton?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Relfex tachycardia; giving beta blockers
Integration of viral DNA into genome of host hepatocytes

6. What is the neurologic manifestation of ADPKD?
Hexokinase
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Acute gastric mucosal defects (superficial or full thickness)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

7. What are the two growth factors associated with angiogenesis?
women
FGF and VEGF
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Skin flushing and warmth; prostaglandins; give with aspirin

8. what hernia has a similar mechanism to hydrocele?
Hyperkalemia; potassium sparing diuretics - potassium supplements
I is more benign and can present later in adulthood
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Fat - fertile - forty - female

9. is Rifampin ever used as monotherapY? why either way?
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
11
Radial nerve damage
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)

10. What is the sole neurologic manifestation of acute rheumatic fever?
Smoking
Sydenham chorea
Inhaled animal dander allergens
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

11. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Thymic tumor
Tibial
Folic acid treatment!

12. where are the two classical places that the ulnar nerve can be injured?

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13. which RPGN is also called pauci immune GN? why?
Both sides
Reiter syndrome; B27
ANCA because of lack of Ig and C3 deposits on IF
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

14. in the LV and aorta - What are the pressures?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Normally close to systolic
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

15. What is extraocular muscle weakness a common symptom of?
Well
Myasthenia gravis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Dihydropyridine sensitive Ca channels (L type)

16. What actions increase venous return?
Dissolved in plasma and attached to Hgb
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Squatting - sitting - lying supine - passive leg raising
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

17. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hypertension - edema - and proteinuria
Vertical diplopia
Hexokinase
Strength of cell mediated immune response

18. which are the only glycosylated proteins in HIV virus?
GI malignancies and Insulin resistance (acromegal for ex)
Env genes (for getting into target cells)
RER; copper
chronic urticaria and allergic symptoms

19. What type of drug is alendronate?
Adeno
SS +rNA
Chorda tympani branch
Biphosphonate

20. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
ATP binding (resets the myosin head to contract again for next binding)
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)

21. metabolism of 1 gram of protein produces How many calories? carb? fat?
200-500
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Bile soluble which means they are bile sensitive
4 - 4 - 9

22. What is normal fibrinogen levels?
Insulin like growth factor 1 (just another name)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Increases
200-500

23. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Proteasome inhibitor; treatment for MM and waldenstroms
manifestations - congenital (stretching of periventricular pyrimadal fibers)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Little effect on cell and no change

24. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Nonsense; mRNA processing
Hexokinase
Tzanck smear

25. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Brief psychotic disorder; schizophreniform; schizophrenia
Downs; regurgitant AV valves - ASDs
FGF and VEGF

26. SIADH patients have normal blood volume but...
Think Hb deformation diseases
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
High potassium conductance and some sodium conductance
hyponatremia (aldosterone activation equilibrates body volume)

27. Where is the base of the heart? apex?
Acute interstitial nephritis
Biphosphonate
Closer to head; closer to diaphragm
Turners`

28. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
hyponatremia (aldosterone activation equilibrates body volume)
Highly negative resting potential
E6 and E7 of HPV knock off p53 and Rb suppressor genes

29. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
frameshift mutations (missense is substitution)
Vagus (auricular branch); vasovagal syncope!
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Drug induced interstitial nephritis

30. within the right atrium - What is the maximum pressure? left atrium?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
As a CO2 carrier with the carboxylase enzyme
Normally close to systolic
8; 12

31. other than parvo B19 - what else is associated with red cell aplasia?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
P450 mitochondrial monooxygenase
Thymic tumor
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

32. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Decreases both
Vascular endothelium; protease

33. What is intussusception? how does ischemia and necrosis occur?
Standing suddenly from supine position; valsalva maneuver
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
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

34. which opponens muscle does ulnar innervate?
Adductor
Dihydropyridine sensitive Ca channels (L type)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Myasthenia gravis

35. What is acanthosis nigricans associated with?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
GI malignancies and Insulin resistance (acromegal for ex)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

36. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
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
Terminal bronchioles; small bronchi
Ig A deficiency
Varying; erythema nodosum is common

37. What is used to prevent vertical transmission of HIV?
Elastance
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
E. coli; staphylococcus saprophyticus
ZDV or AZT

38. Where does complement bind on the Fc region of Ig chains?
Acute gastric mucosal defects (superficial or full thickness)
OCPs - multiparity - breast feeding
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
No; yes

39. what bursa is affected when on knees like a maid/gardner?
Lateral; RV; RA; LV
Prepatellar
Pain reliever - reduces pain by locking substance P in the PNS
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

40. In what population does cholelithiasis occur?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
P53 mutation; AD
facultative intracellular
Fat - fertile - forty - female

41. What is the most important prognostic indicator in patients with malignant melanoma?
Brief psychotic disorder; schizophreniform; schizophrenia
Measure of depth invasion (vertical!)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Common peroneal; bony fractures and compression; sciatic

42. How can renal blood flow be calculated from RPF?
In the extracellular space
RBF= PAH clearance/(1- hematocrit)
25; 25
Highly negative resting potential

43. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Neisseria induced small cell vasculitis (including hands and soles)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Rabies encephalitis from cave bats; rabies killed vaccines
Octreotide

44. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Reiter syndrome; B27
RBF= PAH clearance/(1- hematocrit)

45. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
MAO inhibitors; wine and cheese
G to T in p53; HCC

46. what vessel would a fracture to the neck of the of the humerus damage?
Biphosphonate
Recurrent larygneal
Anterior circumflex (and axillary nerve)
In ER of bile canaliculi

47. h1 receptor anatagonists are not effective in treatment of asthma only for...
Well
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Drink plenty of fluids
chronic urticaria and allergic symptoms

48. What test would be best to determine if a gene is being transcribed? translated?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Prepatellar
Southern - western
E. coli

49. What does protein M do in Group A strep<
Prevent phagocytosis
Mean greater than median greater than mode
frameshift mutations (missense is substitution)
SSRI

50. What are the primary determinants of colon cancer risk in UC patients
Apocrine; eccrine
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Duration and extent of disease
ATP binding (resets the myosin head to contract again for next binding)

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USMLE Prep 2

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