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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 does C1 esterase do other than inhibiting complement pathway?
Pulmonary hypertension
Inactivates kallikrein which activates kininogen into bradykinin
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
SaO2 <92%

2. carnitine deficiency impairs production of What and how?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Ketone body production by preventing fatty acids into the mitochondria
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Diabetic microangiopathy

3. What is omalizumab and What is it used for?
Coagulation factors are made in the liver
Right before diastole (filling begins)
Fibrosis; macrophages
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

4. What does sustained hand grip do to the C/V system?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Adeno
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Pulmonic and systemic!

5. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Duration and extent of disease
Hexokinase
4 - 4 - 9

6. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Highly negative resting potential
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
Circular - outside nucleus; transport proteins - rRNA - tRNA
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

7. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Biphosphonate
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

8. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Anti cholinergic effects of pupil dilation and lack of accomodation
II; I (I more abundant)
Myasthenia gravis

9. What does VIP do to gastric acid secretion?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Inhibits it
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
Around 70 (normal measured diastolic pressures); 9--

10. nucleotide deletions do not cause missense mutations - they cause...
Pulmonary hypertension
Paramyxo and influenza
frameshift mutations (missense is substitution)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

11. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Nocardia
Prepatellar
Medial circumflex artery; avascular necrosis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

12. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
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)
Bile soluble which means they are bile sensitive
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

13. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
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
Anti cholinergic effects of pupil dilation and lack of accomodation
P450 mitochondrial monooxygenase

14. What is an abortive viral infection?
Strength of cell mediated immune response
Little effect on cell and no change
Pain reliever - reduces pain by locking substance P in the PNS
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

15. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
SVC and IVC; right below the aortic knob
Increase in permeability of two ions with equal and opposite equilibrium potentials
Anterior circumflex (and axillary nerve)

16. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Vascular endothelium; protease
11
Reiter syndrome; B27

17. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
SSRI; erectile dysfunction
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

18. on What part of the clavicle does the SCM attach?
11
Medial part
Anterior circumflex (and axillary nerve)
hyponatremia (aldosterone activation equilibrates body volume)

19. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RR-1/RR

20. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Folic acid treatment!
Normally close to systolic
Apocrine; eccrine
SSRI; erectile dysfunction

21. What is contraindicated in toxic mega colon?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Sydenham chorea
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
hyponatremia (aldosterone activation equilibrates body volume)

22. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
In ER of bile canaliculi
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

23. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Inhibits it
Protamine sulfate
Gluteus maximus; difficulty getting up from seated position and climbing chair
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

24. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
ANCA because of lack of Ig and C3 deposits on IF
No and yes
Serum creatine kinase; reperfusion injury causes necrosis
The term used to describe decreased drug responsiveness with repeated administration

25. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
200-500

26. What is the mc location of brain germinomas?What are the classic symptoms?
Closer to head; closer to diaphragm
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Serum FFA and serum triglyceride levels
ZDV or AZT

27. What effects does cortisol have on catecholamines?
Fat - fertile - forty - female
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
Ketone body production by preventing fatty acids into the mitochondria
As a CO2 carrier with the carboxylase enzyme

28. which are the only glycosylated proteins in HIV virus?
II; I (I more abundant)
Env genes (for getting into target cells)
Medial part
46 - 4N; 23 2N

29. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
The term used to describe decreased drug responsiveness with repeated administration
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Fibronectin - laminin - collagen

30. What is capsaicin? Where does it work?
Anti cholinergic effects of pupil dilation and lack of accomodation
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Pain reliever - reduces pain by locking substance P in the PNS

31. Where does conjugation of bilirubin take place?
Increased reticulocytes
In ER of bile canaliculi
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Dissolved in plasma and attached to Hgb

32. What is the mainstay treatment for acute mania?
SSRI; erectile dysfunction
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Ig A deficiency

33. name three pathological states that present with large tongues.
Relfex tachycardia; giving beta blockers
In ER of bile canaliculi
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

34. SIADH patients have normal blood volume but...
8 (myc protein) with 2 - 14 - 22 (iG chains)
hyponatremia (aldosterone activation equilibrates body volume)
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
4 - 4 - 9

35. What does the tuberoinfundibular pathway connect? What is it responsible for?
RER; copper
Amiadarone
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Medullary

36. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Vancomycin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

37. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
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
Enterococci (e. faecalis)- found on genitalia area
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

38. Where is conduction in heart fastest? slowest?
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)
Ceftriaxone; azithromycin
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)
Purkinje system; AV node

39. In what form are mitochondrial DNA? What do they transcribe?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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
Increase; decreased
Circular - outside nucleus; transport proteins - rRNA - tRNA

40. How do bradykinin - C3a and C5a cause edema?
Close but purkinje system to ensure contraction in a bottom up fashion
By vascular permeability and vasodilation
Right heart failure
Octreotide

41. why is crohns disease associated with oxaloacetate kidney stones?
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
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
Right heart failure
ZDV or AZT

42. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Dihydropyridine sensitive Ca channels (L type)
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
G to T in p53; HCC

43. IL4 is used for isotypye switching to what?
IgE
Increased reticulocytes
Fibrosis; macrophages
Large stroke volumes with ventricular contraction; aortic regurg

44. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Ketone body production by preventing fatty acids into the mitochondria
Integration of viral DNA into genome of host hepatocytes
RBC mass; epo levels (secondary has high)
Enterococci (e. faecalis)- found on genitalia area

45. sporadic colon cancer tend to arise From what type of polyps?
Strength of cell mediated immune response
Single adenomatous ones
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Vertical diplopia

46. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Drug induced interstitial nephritis
Recurrent larygneal

47. What is used to treat heparin toxicity?
As a CO2 carrier with the carboxylase enzyme
Protamine sulfate
Octreotide
Around 70 (normal measured diastolic pressures); 9--

48. What is the most important prognostic indicator in patients with malignant melanoma?
Anti cholinergic effects of pupil dilation and lack of accomodation
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Measure of depth invasion (vertical!)
When it invades the bm; carcinoma in situ

49. What are two common side effects of both acute and long acting nitrates? What causes them?
Tibial
Headaches and facial flushing; vasodilation in meninges and skin
Echinococcus granulosus; anaphylaxis
Acute gastric mucosal defects (superficial or full thickness)

50. is Rifampin ever used as monotherapY? why either way?
TCAs and prazosin
Pulmonary hypertension
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
Well