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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. What does protein M do in Group A strep<
S. saprophyticus - and s. epidermidis; novobiocin
Another type of aldosterone antagonist (like spironolactone)
Vagus nerve stimulation
Prevent phagocytosis

2. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Trauma to stereociliated hair cells of the organ of corti
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
DIC; TTP- HUS dont bleed that much
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

3. In what form are mitochondrial DNA? What do they transcribe?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Circular - outside nucleus; transport proteins - rRNA - tRNA
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

4. What causes the blurry vision side effects in first generation anti histamines?
No; yes
Anti cholinergic effects of pupil dilation and lack of accomodation
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

5. what diseases can vit A be used to treat?
Increases cytokine production
Adeno
Measles and M3 AML`
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

6. which opponens muscle does ulnar innervate?
Adductor
Think Hb deformation diseases
RER; RER
Susceptible; soluble (unable to be cultured in bile)

7. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anti centromere; anti DNA topoisomerase

8. What is the cause of fixed splitting of S2? why?
RBC mass; epo levels (secondary has high)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
SVT; increases vagal tone; rectus abdominis

9. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Primary
SSRI
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe

10. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
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
200-500
Downs; regurgitant AV valves - ASDs
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

11. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
C3 decreased after 5-10 days; sulfonamides
Octreotide

12. What is a cord factor and Which bugs have it? How do they appear on culture?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
FGF and VEGF
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)

13. at three years of age What are social - fine motor - gross motor and language developments?
Syringomelia
Well trained athletes and children
Prevents hepatic VLDL production
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

14. What are two common side effects of both acute and long acting nitrates? What causes them?
Brief psychotic disorder; schizophreniform; schizophrenia
Headaches and facial flushing; vasodilation in meninges and skin
No; yes
RBF= PAH clearance/(1- hematocrit)

15. What can cause aortic regurg? What is the heart sound you hear?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Common peroneal; bony fractures and compression; sciatic
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hypothyroidism

16. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
RER; RER
Because of vasodiation to skeletal muscles
GI malignancies and Insulin resistance (acromegal for ex)

17. what induces bronchial squamous metaplasia?
Varying; erythema nodosum is common
Adductor
Smoking
Nonsense; mRNA processing

18. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Barium enema
Reiter syndrome; B27
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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

19. what has the greatest effect on prognosis when treating c. diptheriae?
low in serum
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

20. What is the Na/Ca exchange used for?
Medial part
To pump calcium out in cardiac myocytes so that relaxation occurs
Underestimation of gestational age
GI malignancies and Insulin resistance (acromegal for ex)

21. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
facultative intracellular
Hypo or hyper pigmentations; after tanning
Rabies encephalitis from cave bats; rabies killed vaccines

22. SIADH patients have normal blood volume but...
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
E6 and E7 of HPV knock off p53 and Rb suppressor genes
frameshift mutations (missense is substitution)
hyponatremia (aldosterone activation equilibrates body volume)

23. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
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
Prepatellar
Radial nerve and deep brachial artery
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

24. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
RER; RER
Vagus nerve stimulation
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

25. 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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26. What are two indicators of chronic alcohol consumption?
8; 12
Elevated GGT and macrocytosis
Strength of cell mediated immune response
Gluteus maximus; difficulty getting up from seated position and climbing chair

27. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Hypo or hyper pigmentations; after tanning
Southern - western
Curlings ulcers

28. What is best to prevent GBS infection in a baby?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Chorda tympani branch
In the extracellular space for collagen cross linking; zinc
INTRApartum Abs (ampicillin/penicillin)

29. What type of disease has selective proteinuria? What is found in urine? What is not?
Medullary
II; I (I more abundant)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Turbulence

30. what protects the resting heart from arrhythmias?
low in serum
Because of vasodiation to skeletal muscles
Biphosphonate
Highly negative resting potential

31. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Myasthenia gravis
Medial circumflex artery; avascular necrosis
RER; copper

32. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Bile soluble which means they are bile sensitive

33. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
PDA open

34. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Spongiosis
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)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
No

35. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Become beta pleated and then form neurofibrillary tangle!
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)
Raphe
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

36. What is the most common location of colonization of all s. aureus types?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Anterior nares
Primary
Reiter syndrome; B27

37. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Trauma to stereociliated hair cells of the organ of corti
Nocardia
Leukotriene precursor and does neutrophil chemotaxis

38. IL4 is used for isotypye switching to what?
IgE
frameshift mutations (missense is substitution)
Syncope - angina - dyspnea (SAD)
Elastance

39. What is Bortezomib and What is it used for?
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
Nonsense; mRNA processing
Relfex tachycardia; giving beta blockers
Proteasome inhibitor; treatment for MM and waldenstroms

40. name three pathological states that present with large tongues.
Valproate
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Tzanck smear
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

41. What are the skin presentation in sarcoid?
Tzanck smear
Southern - western
liver specific
Varying; erythema nodosum is common

42. how does increased ICP result in curlings ulcers?
Inhaled animal dander allergens
Mean greater than median greater than mode
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Vagus nerve stimulation

43. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
C3 decreased after 5-10 days; sulfonamides
Syringomelia
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

44. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
SaO2 <92%
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Susceptible; soluble (unable to be cultured in bile)

45. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
(urine PAH x urine flow rate)/plasma PAH
Phencyclidine (PCP)
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)
Because of the low output from heart failure - they will have increased aldosterone levels

46. What is somatomedin C?
Elevated GGT and macrocytosis
Insulin like growth factor 1 (just another name)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

47. what virus causes pharyngoconjuctival fever?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
When it invades the bm; carcinoma in situ
T test; chi squared
Adeno

48. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
SVC and IVC; right below the aortic knob
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
4 - 4 - 9
Cluster

49. What is acanthosis nigricans associated with?
Thymic tumor
GI malignancies and Insulin resistance (acromegal for ex)
S. aureus
Increase lymphatic drainage!

50. What causes release of myosin head from the actin filament?
Inactivates kallikrein which activates kininogen into bradykinin
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
ATP binding (resets the myosin head to contract again for next binding)

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USMLE Prep 2

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