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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 is used to prevent vertical transmission of HIV?
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
Vagus nerve stimulation
Tzanck smear
ZDV or AZT

2. name three pathological states that present with large tongues.
MAC complex (C5b - C9 complement deficiency)
Turbulence
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Headaches and facial flushing; vasodilation in meninges and skin

3. how much percent of sodium is excreted? urea? glucose?
Strength of cell mediated immune response
<1% - 55% - concentration dependent
S3 gallop; S2 to opening snap interval
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

4. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
S. saprophyticus - and s. epidermidis; novobiocin
RBC mass; epo levels (secondary has high)

5. other than increasing HDL levels - what else does niacin do?
Hypertension - edema - and proteinuria
Prevents hepatic VLDL production
SVC and IVC; right below the aortic knob
Reiter syndrome; B27

6. what happens with LDL receptor density in statin therapy?
Increases
I is more benign and can present later in adulthood
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

7. 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?
Medullary
Gluteus medius and minimus; positive trendelenberg
46 - 4N; 23 2N
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

8. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Little effect on cell and no change
Hexokinase
Prostate tumor and increased osteoclast activity

9. which has better side effect profile - SSRI or TCA?
SSRI
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
Folic acid treatment!
Dihydropyridine sensitive Ca channels (L type)

10. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Trochlear nerve (IV); abducens nerve (VI)
Atrial
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
only up to bronchi

11. What do you treat s. epidermidis with?
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
Vancomycin
The term used to describe decreased drug responsiveness with repeated administration
Sydenham chorea

12. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hypothyroidism
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
Kallmans

13. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
AV node slowest - to allow time for diastole
Reticulocytes
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

14. What antibodies are present in CREST? What is the most specific?
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
ZDV or AZT
Abnormal closing of the urethral folds
Anti centromere; anti DNA topoisomerase

15. What does VIP do to gastric acid secretion?
FGF and VEGF
Chlorpheniramine and diphenhydramine
Inhibits it
The term used to describe decreased drug responsiveness with repeated administration

16. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
T test; chi squared
MAO inhibitors; wine and cheese
Prepatellar

17. What is diagnostic (and possible therapeutic for intussusception)?
Intussusception
Barium enema
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
TSh (in testicular tumors can cause hyperthyroidism)

18. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
In the extracellular space for collagen cross linking; zinc
MAC complex (C5b - C9 complement deficiency)

19. What are examples of action that decrease venous return to the heart?
Common peroneal; bony fractures and compression; sciatic
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)
Standing suddenly from supine position; valsalva maneuver
SSRI; erectile dysfunction

20. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Well
RER; copper
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
APP on chrom 21 (this is why downs more susceptible)

21. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Recurrent larygneal
In the extracellular space for collagen cross linking; zinc
RER; RER
Vagus (auricular branch); vasovagal syncope!

22. IL4 is used for isotypye switching to what?
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
Phencyclidine (PCP)
GI malignancies and Insulin resistance (acromegal for ex)
IgE

23. why does variocele occur more in left side?
Think Hb deformation diseases
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Demargination of neutrophils from the vessel walls

24. which RPGN is also called pauci immune GN? why?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
ANCA because of lack of Ig and C3 deposits on IF
Elastance

25. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Trochlear nerve (IV); abducens nerve (VI)
Susceptible; soluble (unable to be cultured in bile)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

26. What are the long term consequences of hydrocephalus?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Chlorpheniramine and diphenhydramine
Covalent (between two cysteines)- allows protein to withstand denaturation
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

27. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Raphe
Close but purkinje system to ensure contraction in a bottom up fashion
S3 gallop; S2 to opening snap interval

28. what clinical findings help distinguish small cell carcinoma?
Trochlear nerve (IV); abducens nerve (VI)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
SSRI; erectile dysfunction
Cluster

29. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
OCPs - multiparity - breast feeding
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Minimal change disease
No; MRI

30. who bleed more DIC or TTP- HUS patients?
Normal; low
Anterior circumflex (and axillary nerve)
DIC; TTP- HUS dont bleed that much
Adeno

31. other than proteinuria - What can cause foamy froathy urine?
Localized dermatologic pain that persists for more than one month after zoster eruption
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
MAC complex (C5b - C9 complement deficiency)
Bile salt accumulation in urine

32. which opponens muscle does ulnar innervate?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
PDA open
Adductor
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

33. SIADH patients have normal blood volume but...
Duration and extent of disease
hyponatremia (aldosterone activation equilibrates body volume)
ZDV or AZT
only up to bronchi

34. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Purkinje system; AV node
In ER of bile canaliculi
Regular insulin (Not fast acting - regular better)

35. Which is faster atrial muscle or ventricular muscle?
Hypo or hyper pigmentations; after tanning
Atrial
Paramyxo and influenza
No (unlike adenomyosis); yes

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

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37. What does anti phospholipid syndrome in SLE patients predispose them to?
Measles and M3 AML`
Headaches and facial flushing; vasodilation in meninges and skin
Varying; erythema nodosum is common
Multiple miscarriages d/t hypercoaguability

38. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Sickle cell; G6PD
Bronchogenic carcinoma
Dissolved in plasma and attached to Hgb
Gluteus medius and minimus; positive trendelenberg

39. PDAs are often asymptomatic. How do you treat?
indomethacin
Drug induced interstitial nephritis
PDA open
To pump calcium out in cardiac myocytes so that relaxation occurs

40. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Well
25; 25
Gluteus maximus; difficulty getting up from seated position and climbing chair
Cluster

41. What is gardeners mydriasis? How is it treated?
High potassium conductance and some sodium conductance
Because of vasodiation to skeletal muscles
RBF= PAH clearance/(1- hematocrit)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

42. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Anti cholinergic effects of pupil dilation and lack of accomodation
Increased reticulocytes
Retinitis; mononucleosis
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

43. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
transcription activation/suppression
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Hypertension - edema - and proteinuria

44. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Around 70 (normal measured diastolic pressures); 9--
Standing suddenly from supine position; valsalva maneuver
Rabies encephalitis from cave bats; rabies killed vaccines

45. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Chorda tympani branch
Circular - outside nucleus; transport proteins - rRNA - tRNA
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

46. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Inactivates kallikrein which activates kininogen into bradykinin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
only up to bronchi
Adeno

47. What does sustained hand grip do to the C/V system?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Smoking
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

48. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Class I
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Another type of aldosterone antagonist (like spironolactone)

49. What type of vision is myopia? In What type of patients does it improve?
TCAs and prazosin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
SaO2 <92%
Pan colitis and right sided colitis (more than left sided and proctitis)

50. 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?
hyponatremia (aldosterone activation equilibrates body volume)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Lateral; RV; RA; LV
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

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USMLE Prep 2

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