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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.
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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. biotin is used By what in tissues responsible for gluconeogenesis
11
Highly negative resting potential
Serum creatine kinase; reperfusion injury causes necrosis
As a CO2 carrier with the carboxylase enzyme

2. 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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3. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Class I
Relfex tachycardia; giving beta blockers
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

4. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
S3 gallop; S2 to opening snap interval
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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

5. What is the presentation of sever aortic stenosis?
Well
8 (myc protein) with 2 - 14 - 22 (iG chains)
Syncope - angina - dyspnea (SAD)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

6. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
SVT; increases vagal tone; rectus abdominis
E. coli; staphylococcus saprophyticus
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

7. which antiarrythmic is associated with blue gray discoloration ?
Because gamma chains replace beta chains and then gamma chain formation wanes
Leukotriene precursor and does neutrophil chemotaxis
Amiadarone
Both sides

8. What is intussusception? how does ischemia and necrosis occur?
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
facultative intracellular
LT (LTD4 - E4 - C4) - and Ach
Common peroneal; bony fractures and compression; sciatic

9. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
SVT; increases vagal tone; rectus abdominis
Because of vasodiation to skeletal muscles
FGF and VEGF
Hypothyroidism

10. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
ATP binding (resets the myosin head to contract again for next binding)
Classical conditioning
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
women

11. What is the immune deficinecy seen in ataxia telangactasia?
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Ig A deficiency
E6 and E7 of HPV knock off p53 and Rb suppressor genes

12. What is best to prevent GBS infection in a baby?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
INTRApartum Abs (ampicillin/penicillin)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

13. 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?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Close but purkinje system to ensure contraction in a bottom up fashion

14. What is subacute sclerosisng encephalitis caused by?
11 aa polypeptide; pain NT in CNS and PNS
Chorda tympani branch
MAO inhibitors; wine and cheese
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

15. how does achalasia present? What does barium swallow show on dilated esophagus?
Syringomelia
Hyperkalemia; potassium sparing diuretics - potassium supplements
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Reticulocytes

16. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Tzanck smear
Chorda tympani branch
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

17. How do you calculate RPF from urine PAH?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Anterior nares
Acute gastric mucosal defects (superficial or full thickness)
(urine PAH x urine flow rate)/plasma PAH

18. When does opening snap begin?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Inhaled animal dander allergens
Right before diastole (filling begins)

19. other than in pyelonephritis - where else are WBC casts seen?
Excessive collagen formation during tissue repair in susceptible individuals
Faulty positioning of the genital tubercle
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Acute interstitial nephritis

20. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
No; MRI
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
AV node slowest - to allow time for diastole

21. what protein is increased in Crohns disease? What does it do?
Hydrogen bonds dictate alpha or beta structure
NF- KB; responsible for cytokine production
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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

22. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Medial part
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
MAC complex (C5b - C9 complement deficiency)

23. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Class I
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

24. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Syncope - angina - dyspnea (SAD)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
IgE

25. What is the diagnosis in delayed puberty plus anosmia?
Serum creatine kinase; reperfusion injury causes necrosis
Dihydropyridine sensitive Ca channels (L type)
Kallmans
S. aureus

26. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
CMV - HSV 1 - Candida
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Serum FFA and serum triglyceride levels

27. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
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
Vascular endothelium; protease
Integration of viral DNA into genome of host hepatocytes

28. What type of drug is alendronate?
To pump calcium out in cardiac myocytes so that relaxation occurs
Raphe
Biphosphonate
Aromatase deficiency in child

29. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
Diabetic microangiopathy
No (unlike adenomyosis); yes
Tzanck smear

30. What are the two coagulase negative staphylococci? How do you distinguish them?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
S. saprophyticus - and s. epidermidis; novobiocin
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

31. What is pickwickian syndrome? What are the lab findings?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
E. coli; staphylococcus saprophyticus
ATP binding (resets the myosin head to contract again for next binding)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

32. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Apocrine; eccrine
Varying; erythema nodosum is common
RER; copper

33. What is extraocular muscle weakness a common symptom of?
Around 70 (normal measured diastolic pressures); 9--
Valproate
Measles and M3 AML`
Myasthenia gravis

34. What are some of the permissive effects of cortisol?
Insulin like growth factor 1 (just another name)
ATP binding (resets the myosin head to contract again for next binding)
Folic acid treatment!
Increases bronchial and vascular smooth muscle reactivity to catecholamines

35. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
High potassium conductance and some sodium conductance

36. What are the acute effects of corticosteroids on the CBC?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Diabetic microangiopathy
Intussusception

37. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Increased reticulocytes
LT (LTD4 - E4 - C4) - and Ach
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

38. What is a common complication of acute pancreatitis? What is it?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
G to T in p53; HCC
Joints d/t increased purine production and thus uric acid production
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

39. how long is substance P? What does it do?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Elevated GGT and macrocytosis
11 aa polypeptide; pain NT in CNS and PNS

40. What can too much IgA in serum produces?
Lateral; RV; RA; LV
Serum creatine kinase; reperfusion injury causes necrosis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Highly negative resting potential

41. What is used to treat heparin toxicity?
Elevated GGT and macrocytosis
4 - 4 - 9
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Protamine sulfate

42. why is crohns disease associated with oxaloacetate kidney stones?
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
DIC; TTP- HUS dont bleed that much
Anterior nares
Multiple miscarriages d/t hypercoaguability

43. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hexokinase
Fibronectin - laminin - collagen
Protamine sulfate

44. how much percent of sodium is excreted? urea? glucose?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
<1% - 55% - concentration dependent
Anterior circumflex (and axillary nerve)

45. which cells produce surfactant? which ones mediate gas exchange?
women
On cardiac tissue and renal juxtaglomerular cells
indomethacin
II; I (I more abundant)

46. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Reticulocytes
Turners`
Chorda tympani branch
11

47. if there are keratin swirls does that mean well or poorly differentiated?
Appetite suppressants
Anterior circumflex (and axillary nerve)
Measles and M3 AML`
Well

48. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Adeno
P53 mutation; AD
Bile soluble which means they are bile sensitive

49. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Medial part
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
Right before diastole (filling begins)

50. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Close but purkinje system to ensure contraction in a bottom up fashion
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities