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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. When does opening snap begin?
Close but purkinje system to ensure contraction in a bottom up fashion
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Right before diastole (filling begins)
gram positive organisms

2. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
GI tract; mood!
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

3. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Pulmonic and systemic!
HSV ( also in utero: chlymadia - neisseria - group B strep)
AV node slowest - to allow time for diastole

4. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Kallmans
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

5. 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
low in serum
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
When it invades the bm; carcinoma in situ

6. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
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
Rabies encephalitis from cave bats; rabies killed vaccines
C3 decreased after 5-10 days; sulfonamides
RER; RER

7. What triggers the neoplastic changes that are associated with HBV infecton?
Apocrine; eccrine
Extrinsic def; instrinsic def; platelet def
Increase by 50% in urine osmolality
Integration of viral DNA into genome of host hepatocytes

8. which nerve provides innervation for plantar flexion and inversion?
No
C3 decreased after 5-10 days; sulfonamides
Tibial
No; MRI

9. What can cause virilization of a mother during pregnancy?
Because gamma chains replace beta chains and then gamma chain formation wanes
Aromatase deficiency in child
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
ATP binding (resets the myosin head to contract again for next binding)

10. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Radial nerve damage
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Biphosphonate

11. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
(urine PAH x urine flow rate)/plasma PAH
Become beta pleated and then form neurofibrillary tangle!
Normal; low
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

12. 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?
Lateral; RV; RA; LV
Curlings ulcers
No; MRI
TCAs and prazosin

13. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Large stroke volumes with ventricular contraction; aortic regurg
Spongiosis
Inhaled animal dander allergens

14. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Pain reliever - reduces pain by locking substance P in the PNS
Large stroke volumes with ventricular contraction; aortic regurg

15. PDAs are often asymptomatic. How do you treat?
Minimal change disease
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
indomethacin
Amiloride - spironolactone - triamterene

16. What do you treat s. epidermidis with?
Increase lymphatic drainage!
RER; RER
Vancomycin
Nonsense; mRNA processing

17. 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
Close but purkinje system to ensure contraction in a bottom up fashion
Bronchial dilation (bronchiectasis)
Sickle cell; G6PD

18. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Dissolved in plasma and attached to Hgb
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)
Increase lymphatic drainage!
Amiloride - spironolactone - triamterene

19. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Medial circumflex artery; avascular necrosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Hypo or hyper pigmentations; after tanning
Well

20. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
Prevent phagocytosis
Hypo or hyper pigmentations; after tanning

21. what dictates the resting membrane potential of most cells?
SaO2 <92%
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
High potassium conductance and some sodium conductance
Tissue redistribution (out of plasma) rather than metabolism

22. why is crohns disease associated with oxaloacetate kidney stones?
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
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
Hypertension - edema - and proteinuria

23. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Duration and extent of disease
Inhaled animal dander allergens
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

24. other than proteinuria - What can cause foamy froathy urine?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Bile salt accumulation in urine
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

25. What is epispadias caused by?
Syncope - angina - dyspnea (SAD)
Right before diastole (filling begins)
Faulty positioning of the genital tubercle
Skin flushing and warmth; prostaglandins; give with aspirin

26. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
ATP binding (resets the myosin head to contract again for next binding)
SSRI; erectile dysfunction
RER; copper
Close but purkinje system to ensure contraction in a bottom up fashion

27. 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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28. which opponens muscle does ulnar innervate?
Adductor
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Increase lymphatic drainage!

29. What is capacitance inversely proportional to?
SSRI; erectile dysfunction
transcription activation/suppression
Elastance
The time interval between S2 and OS- the shorter the interval - the more intense

30. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Normal; low
Covalent (between two cysteines)- allows protein to withstand denaturation
Retinitis; mononucleosis
No; yes

31. What three pathogens cause infectious esophagitis in HIV positive patients?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
CMV - HSV 1 - Candida
Proteasome inhibitor; treatment for MM and waldenstroms
Normal; low

32. What is used to compare means? categorical outcomes?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Mean greater than median greater than mode
T test; chi squared
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

33. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
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
Brief psychotic disorder; schizophreniform; schizophrenia
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Skin flushing and warmth; prostaglandins; give with aspirin

34. What antibiotic is best to treat alcoholic pulm infections? why?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Prostate tumor and increased osteoclast activity
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Clindamycin; covers anaerobic oral flora and aerobic bacteria

35. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Dihydropyridine sensitive Ca channels (L type)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Medullary
Increase; decreased

36. do Class IC agents prolong the QT interval?
P450 mitochondrial monooxygenase
No
SS +rNA
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

37. What does NF- KB do?
Prevent phagocytosis
Increases cytokine production
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Thymic tumor

38. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Well trained athletes and children
Curlings ulcers
Right before diastole (filling begins)
Anti centromere; anti DNA topoisomerase

39. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Highly negative resting potential
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
Acute gastric mucosal defects (superficial or full thickness)
No; MRI

40. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Gluteus medius and minimus; positive trendelenberg
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Relfex tachycardia; giving beta blockers
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

41. What are diastolic (lowest) pressures in aorta? LV?
Measure of depth invasion (vertical!)
Around 70 (normal measured diastolic pressures); 9--
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
manifestations - congenital (stretching of periventricular pyrimadal fibers)

42. If a patient has higher levels of HbF - What does this mean?
TCAs and prazosin
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Think Hb deformation diseases

43. What is difference between Arnold Chiari type I and II?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
G to T in p53; HCC
I is more benign and can present later in adulthood
Retinitis; mononucleosis

44. what hormone is structurally similar to hCG?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
TSh (in testicular tumors can cause hyperthyroidism)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
DIC; TTP- HUS dont bleed that much

45. Would alpha 1 agonists cause flushing? muscarinic antagonist?
SVT; increases vagal tone; rectus abdominis
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
No; yes
Barium enema

46. What is best to prevent GBS infection in a baby?
Amiadarone
Close but purkinje system to ensure contraction in a bottom up fashion
INTRApartum Abs (ampicillin/penicillin)
E. coli

47. When is an S4 sound normal?
Multiple miscarriages d/t hypercoaguability
Bile salt accumulation in urine
Well trained athletes and children
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

48. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
APP on chrom 21 (this is why downs more susceptible)
Echinococcus granulosus; anaphylaxis
Southern - western
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

49. What are the two growth factors associated with angiogenesis?
FGF and VEGF
V fib; v. failure
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
Superior larygeal; cricothyroid; recurrent laryngeal

50. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
S. aureus
Duration and extent of disease

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USMLE Prep 2

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