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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. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
By vascular permeability and vasodilation
Faulty positioning of the genital tubercle
The time interval between S2 and OS- the shorter the interval - the more intense

2. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
chronic urticaria and allergic symptoms
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

3. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Env genes (for getting into target cells)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
...

4. What does prolonged PT indicated? aPTT? bleeding time?
GI tract; mood!
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Extrinsic def; instrinsic def; platelet def
Hypothyroidism

5. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
P53 mutation; DCC is also required for adenoma to carcinoma
Leukotriene precursor and does neutrophil chemotaxis

6. What test would be best to determine if a gene is being transcribed? translated?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Because gamma chains replace beta chains and then gamma chain formation wanes
Underestimation of gestational age
Southern - western

7. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Bronchogenic carcinoma
SSRI

8. Where does lysyl oxidase act? What is the cofactor for that?
Anti cholinergic effects of pupil dilation and lack of accomodation
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)
In the extracellular space for collagen cross linking; zinc
Extrinsic def; instrinsic def; platelet def

9. what enzyme converts procarcinogens into carcinogens?
Sarcoid
Medial circumflex artery; avascular necrosis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
P450 mitochondrial monooxygenase

10. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Hypo or hyper pigmentations; after tanning
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Increase; decreased
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

11. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Duration and extent of disease
SaO2 <92%
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Increase lymphatic drainage!

12. What is used to prevent vertical transmission of HIV?
Rabies encephalitis from cave bats; rabies killed vaccines
Clindamycin; covers anaerobic oral flora and aerobic bacteria
ZDV or AZT
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

13. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Phencyclidine (PCP)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
TCAs and prazosin
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

14. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
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
No; yes
Both sides

15. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
IgE
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)
Vertical diplopia

16. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Highly negative resting potential
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
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
Increase in permeability of two ions with equal and opposite equilibrium potentials

17. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Increase by 50% in urine osmolality
As a CO2 carrier with the carboxylase enzyme
Hydrogen bonds dictate alpha or beta structure

18. When is an S4 sound normal?
Inhibits it
Well trained athletes and children
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
low in serum

19. 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?
46 - 4N; 23 2N
Extrinsic def; instrinsic def; platelet def
DIC; TTP- HUS dont bleed that much
hyponatremia (aldosterone activation equilibrates body volume)

20. What does extended consumption of appetite suppressants lead to?
No and yes
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Pulmonary hypertension

21. What is somatomedin C?
Acute gastric mucosal defects (superficial or full thickness)
Increases
Bile soluble which means they are bile sensitive
Insulin like growth factor 1 (just another name)

22. at four years of age - What are the social - fine motor - gross motor - and language developments?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Gluteus maximus; difficulty getting up from seated position and climbing chair
Amiloride - spironolactone - triamterene
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

23. within the right ventricle - What are maximum pressures? the pulm arter?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hexokinase
25; 25
II; I (I more abundant)

24. 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?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
frameshift mutations (missense is substitution)
HSV ( also in utero: chlymadia - neisseria - group B strep)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

25. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
200-500
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
S. saprophyticus - and s. epidermidis; novobiocin
Syringomelia

26. What is the mutation type in thalassemias? what process is defective because of this?
RBF= PAH clearance/(1- hematocrit)
Nonsense; mRNA processing
Susceptible; soluble (unable to be cultured in bile)
Myasthenia gravis

27. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Class I
Gluteus medius and minimus; positive trendelenberg
Sarcoid

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

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29. What can too much IgA in serum produces?
Vancomycin; histamine mediated
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Measure of depth invasion (vertical!)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

30. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Squatting - sitting - lying supine - passive leg raising
Env genes (for getting into target cells)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
women

31. What are the three dopaminergic systems and What are they responsible for? disease?
Purkinje system; AV node
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Chorda tympani branch
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

32. How do you calculate atributable risk percent?
RR-1/RR
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Acute gastric mucosal defects (superficial or full thickness)
<1% - 55% - concentration dependent

33. what indicates the severity of a mitral regurg ? mitral stenosis?
Abnormal closing of the urethral folds
CGD; t cell dysfxn (diGeorge)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
S3 gallop; S2 to opening snap interval

34. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
HSV and VZV
Sarcoid
8 (myc protein) with 2 - 14 - 22 (iG chains)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

35. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Amiloride - spironolactone - triamterene
To pump calcium out in cardiac myocytes so that relaxation occurs
Reticulocytes

36. What causes the blurry vision side effects in first generation anti histamines?
P450 mitochondrial monooxygenase
Anti cholinergic effects of pupil dilation and lack of accomodation
Syringomelia
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

37. If a patient has higher levels of HbF - What does this mean?
women
Think Hb deformation diseases
Inhaled animal dander allergens
Increases cytokine production

38. what happens with LDL receptor density in statin therapy?
Nocardia
Increases
Octreotide
Decreases both

39. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
(urine PAH x urine flow rate)/plasma PAH
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Phencyclidine (PCP)

40. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
200-500
No
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Valproate

41. What is used to compare means? categorical outcomes?
T test; chi squared
Class I
SSRI
SVT; increases vagal tone; rectus abdominis

42. Metronidizaole does not cover...
gram positive organisms
Extrinsic def; instrinsic def; platelet def
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Common peroneal; bony fractures and compression; sciatic

43. on which chromosome is wilms tumor found?
Pulmonic and systemic!
Prevent phagocytosis
Proteasome inhibitor; treatment for MM and waldenstroms
11

44. What are fenfluramine - phentermine?
Single adenomatous ones
IgE
Appetite suppressants
Ether and other organic solvents

45. what virus causes pharyngoconjuctival fever?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Class I
Normally close to systolic
Adeno

46. What is the mc location for avascular necrosis? What is it associated with?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Downs; regurgitant AV valves - ASDs
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Proteasome inhibitor; treatment for MM and waldenstroms

47. what induces bronchial squamous metaplasia?
P53 mutation; AD
Smoking
Integration of viral DNA into genome of host hepatocytes
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

48. nucleotide deletions do not cause missense mutations - they cause...
Downs; regurgitant AV valves - ASDs
frameshift mutations (missense is substitution)
Duration and extent of disease
Southern - western

49. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Turners`
Reiter syndrome; B27
Aromatase deficiency in child

50. What is easiest way to treat nephrolithiasis?
Sickle cell; G6PD
Biphosphonate
Hypo or hyper pigmentations; after tanning
Drink plenty of fluids