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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 congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Drink plenty of fluids
Demargination of neutrophils from the vessel walls
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
SVC and IVC; right below the aortic knob

2. When does opening snap begin?
Neisseria induced small cell vasculitis (including hands and soles)
Right before diastole (filling begins)
When it invades the bm; carcinoma in situ
Anti - apoptotic (prevents going into apoptosis)- 18; 14

3. 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?
only up to bronchi
Well trained athletes and children
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Lateral; RV; RA; LV

4. what drug is useful for secretory diarrhea?
Because of vasodiation to skeletal muscles
Octreotide
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
200-500

5. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
11 aa polypeptide; pain NT in CNS and PNS
Headaches and facial flushing; vasodilation in meninges and skin
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
No (unlike adenomyosis); yes

6. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Minimal change disease
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Nocardia
Increase lymphatic drainage!

7. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Neisseria induced small cell vasculitis (including hands and soles)
Curlings ulcers
Prepatellar
Selective alpha 1 (increases SVR)

8. What type of mutation does aflatoxin cause? what cancer does this increase for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Echinococcus granulosus; anaphylaxis
G to T in p53; HCC
Chorda tympani branch

9. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
No (unlike adenomyosis); yes
Raphe
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

10. in B12 deficiency - what levels in blood rise very quickly and then drop?
Amiloride - spironolactone - triamterene
IgE
Joints d/t increased purine production and thus uric acid production
Reticulocytes

11. which has better side effect profile - SSRI or TCA?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
(urine PAH x urine flow rate)/plasma PAH
SSRI
MAO inhibitors; wine and cheese

12. PDAs are often asymptomatic. How do you treat?
Relfex tachycardia; giving beta blockers
Chlorpheniramine and diphenhydramine
indomethacin
Intussusception

13. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
When it invades the bm; carcinoma in situ
Chrom 8
DIC; TTP- HUS dont bleed that much

14. What is used to treat heparin toxicity?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Protamine sulfate

15. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Bronchial dilation (bronchiectasis)
Circular - outside nucleus; transport proteins - rRNA - tRNA
chronic urticaria and allergic symptoms

16. which nucleus releases serotonin?
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
Raphe
facultative intracellular
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

17. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Downs; regurgitant AV valves - ASDs
Increased reticulocytes

18. 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)
MAO inhibitors; wine and cheese
Diabetic microangiopathy
11 aa polypeptide; pain NT in CNS and PNS

19. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

20. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
To pump calcium out in cardiac myocytes so that relaxation occurs
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
NF- KB; responsible for cytokine production

21. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Decreases both
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)

22. why are pregnant predisposed to cholelithiasis?
facultative intracellular
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

23. What is the best indicator for the severity of mitral stenosis?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
The time interval between S2 and OS- the shorter the interval - the more intense
Biphosphonate
Kallmans

24. where are the vegetations on the valves of a libman sacks endocarditis?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Both sides
Increase lymphatic drainage!

25. what enzyme converts procarcinogens into carcinogens?
Bronchogenic carcinoma
Terminal bronchioles; small bronchi
P450 mitochondrial monooxygenase
Dihydropyridine sensitive Ca channels (L type)

26. What type of endocarditis is cytoscopy induced?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Enterococci (e. faecalis)- found on genitalia area
Hydrogen bonds dictate alpha or beta structure
Southern - western

27. why is glucagon used in beta blocker toxicitiy?
differentiate
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Dissolved in plasma and attached to Hgb
transcription activation/suppression

28. What causes wrist drop?
In the extracellular space for collagen cross linking; zinc
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Radial nerve damage

29. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
RER; RER
Smoking
Duration and extent of disease
C3 decreased after 5-10 days; sulfonamides

30. What is tachyphylaxis?
CGD; t cell dysfxn (diGeorge)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
The term used to describe decreased drug responsiveness with repeated administration
RER; RER

31. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
T test; chi squared
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Excessive collagen formation during tissue repair in susceptible individuals

32. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Relfex tachycardia; giving beta blockers
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Smoking

33. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Rabies encephalitis from cave bats; rabies killed vaccines
Myasthenia gravis
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
To pump calcium out in cardiac myocytes so that relaxation occurs

34. How can renal blood flow be calculated from RPF?
Vertical diplopia
Circular - outside nucleus; transport proteins - rRNA - tRNA
Pan colitis and right sided colitis (more than left sided and proctitis)
RBF= PAH clearance/(1- hematocrit)

35. what hormone is structurally similar to hCG?
Gluteus medius and minimus; positive trendelenberg
Smoking
Underestimation of gestational age
TSh (in testicular tumors can cause hyperthyroidism)

36. a patient fearing all white coats is a phenomenon of what?
Recurrent larygneal
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Classical conditioning
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

37. What does p53 do? what chrom is it on?
As a CO2 carrier with the carboxylase enzyme
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

38. What does VIP do to gastric acid secretion?
Inhibits it
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Sickle cell; G6PD
ZDV or AZT

39. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
8; 12
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

40. What is capacitance inversely proportional to?
Elastance
Medial circumflex artery; avascular necrosis
Increase; decreased
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

41. IL4 is used for isotypye switching to what?
Prevents hepatic VLDL production
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
IgE

42. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Normal; low
Dihydropyridine sensitive Ca channels (L type)
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)

43. What is an abortive viral infection?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Initiation - pointing; pincer grasp; walking; mama/dada
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Little effect on cell and no change

44. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Normal; low
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Rabies encephalitis from cave bats; rabies killed vaccines
Little effect on cell and no change

45. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Downs; regurgitant AV valves - ASDs
Fat - fertile - forty - female
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
SVC and IVC; right below the aortic knob

46. What is used to compare means? categorical outcomes?
T test; chi squared
LT (LTD4 - E4 - C4) - and Ach
Terminal bronchioles; small bronchi
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

47. What antibodies are present in CREST? What is the most specific?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
In the extracellular space
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Anti centromere; anti DNA topoisomerase

48. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Because of vasodiation to skeletal muscles
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

49. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Appetite suppressants
ANCA because of lack of Ig and C3 deposits on IF

50. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Hypertension - edema - and proteinuria
I is more benign and can present later in adulthood
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

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USMLE Prep 2

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