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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 aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Kallmans
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
chronic urticaria and allergic symptoms

2. what clinical findings help distinguish small cell carcinoma?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
ZDV or AZT
The term used to describe decreased drug responsiveness with repeated administration

3. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Prostate tumor and increased osteoclast activity
Inhibits it
P53 mutation; DCC is also required for adenoma to carcinoma
Vancomycin; histamine mediated

4. In what form are mitochondrial DNA? What do they transcribe?
Proteasome inhibitor; treatment for MM and waldenstroms
Demargination of neutrophils from the vessel walls
Circular - outside nucleus; transport proteins - rRNA - tRNA
Medullary

5. Where does conjugation of bilirubin take place?
Pain reliever - reduces pain by locking substance P in the PNS
In ER of bile canaliculi
Medullary
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

6. 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
Protamine sulfate
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Increase in permeability of two ions with equal and opposite equilibrium potentials

7. in B12 deficiency - what levels in blood rise very quickly and then drop?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
P450 mitochondrial monooxygenase
Reticulocytes
Faulty positioning of the genital tubercle

8. What is the diagnosis in delayed puberty plus anosmia?
Tzanck smear
Kallmans
Nonsense; mRNA processing
Purkinje system; AV node

9. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Bile salt accumulation in urine
Increased reticulocytes
Chorda tympani branch
Another type of aldosterone antagonist (like spironolactone)

10. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
To pump calcium out in cardiac myocytes so that relaxation occurs
Apocrine; eccrine
Pulmonary hypertension

11. at four years of age - What are the social - fine motor - gross motor - and language developments?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Abnormal closing of the urethral folds
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

12. how much percent of sodium is excreted? urea? glucose?
Closer to head; closer to diaphragm
Circular - outside nucleus; transport proteins - rRNA - tRNA
In ER of bile canaliculi
<1% - 55% - concentration dependent

13. How do you explain the selective proteinuria of loss to albumin only in MCD?
APP on chrom 21 (this is why downs more susceptible)
Medial circumflex artery; avascular necrosis
Demargination of neutrophils from the vessel walls
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

14. What is congestive hepatomegaly specific for?
S. aureus
C3 decreased after 5-10 days; sulfonamides
(urine PAH x urine flow rate)/plasma PAH
Right heart failure

15. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
women
Single adenomatous ones
Right heart failure

16. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Pulmonary hypertension
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Squatting - sitting - lying supine - passive leg raising

17. What is subacute sclerosisng encephalitis caused by?
CMV - HSV 1 - Candida
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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

18. What agonists reduce the gradient across the LV outflow tract?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Selective alpha 1 (increases SVR)
In ER of bile canaliculi
SaO2 <92%

19. which nerve provides innervation for plantar flexion and inversion?
Tibial
Normally close to systolic
MAC complex (C5b - C9 complement deficiency)
Adductor

20. why are pregnant predisposed to cholelithiasis?
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
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
Southern - western
Anti cholinergic effects of pupil dilation and lack of accomodation

21. carnitine deficiency impairs production of What and how?
Covalent (between two cysteines)- allows protein to withstand denaturation
Both sides
Ketone body production by preventing fatty acids into the mitochondria
Terminal bronchioles; small bronchi

22. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Abnormal closing of the urethral folds
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Standing suddenly from supine position; valsalva maneuver

23. what kind of drug is sertraline? What is a common side effect?
Hexokinase
SVC and IVC; right below the aortic knob
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
SSRI; erectile dysfunction

24. 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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Anti centromere; anti DNA topoisomerase
SSRI

25. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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26. What is the mcc of elevated AFP leves in pregnancy>
Prepatellar
Turbulence
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Underestimation of gestational age

27. What does sustained hand grip do to the C/V system?
Prevents hepatic VLDL production
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Lateral; RV; RA; LV
Syringomelia

28. what dictates the resting membrane potential of most cells?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
No; yes
High potassium conductance and some sodium conductance
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

29. What is damaged in early syringomelia? later?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Squatting - sitting - lying supine - passive leg raising
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

30. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Acute gastric mucosal defects (superficial or full thickness)
Brief psychotic disorder; schizophreniform; schizophrenia
Smoking
Increase; decreased

31. If a patient has higher levels of HbF - What does this mean?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
S. saprophyticus - and s. epidermidis; novobiocin
Think Hb deformation diseases
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

32. What is capacitance inversely proportional to?
Chorda tympani branch
Downs; regurgitant AV valves - ASDs
Elastance
Demargination of neutrophils from the vessel walls

33. How can renal blood flow be calculated from RPF?
gram positive organisms
Headaches and facial flushing; vasodilation in meninges and skin
RBF= PAH clearance/(1- hematocrit)
Highly negative resting potential

34. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Biphosphonate
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

35. 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?
Barium enema
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Dihydropyridine sensitive Ca channels (L type)
46 - 4N; 23 2N

36. what vessel would a fracture to the neck of the of the humerus damage?
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
Prevents hepatic VLDL production
Anterior circumflex (and axillary nerve)
Measure of depth invasion (vertical!)

37. non ceruloplasmin deposition - ceruloplasmin is...
Apocrine; eccrine
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
low in serum

38. What can cause virilization of a mother during pregnancy?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
When it invades the bm; carcinoma in situ
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Aromatase deficiency in child

39. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
SaO2 <92%
Fibrosis; macrophages
To pump calcium out in cardiac myocytes so that relaxation occurs

40. what indicates the severity of a mitral regurg ? mitral stenosis?
Prepatellar
Prevents hepatic VLDL production
Regular insulin (Not fast acting - regular better)
S3 gallop; S2 to opening snap interval

41. What actions increase venous return?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Drug induced interstitial nephritis
Env genes (for getting into target cells)
Squatting - sitting - lying supine - passive leg raising

42. What is the mainstay treatment for acute mania?
Drug induced interstitial nephritis
Prostate tumor and increased osteoclast activity
Relfex tachycardia; giving beta blockers
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

43. the rate of blood flow of which two circulations must equal each other at all times?
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
SVT; increases vagal tone; rectus abdominis
Pulmonic and systemic!
ZDV or AZT

44. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
TCAs and prazosin
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
Ketone body production by preventing fatty acids into the mitochondria
Nocardia

45. what murmur is enhanced by decreased blood flow to the heart?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
GI tract; mood!
4 - 4 - 9
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

46. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
INTRApartum Abs (ampicillin/penicillin)
DIC; TTP- HUS dont bleed that much
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

47. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Think Hb deformation diseases
ANCA because of lack of Ig and C3 deposits on IF
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
OCPs - multiparity - breast feeding

48. What is normal fibrinogen levels?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
11 aa polypeptide; pain NT in CNS and PNS
200-500
Integration of viral DNA into genome of host hepatocytes

49. What is used to compare means? categorical outcomes?
T test; chi squared
Apocrine; eccrine
Gluteus maximus; difficulty getting up from seated position and climbing chair
Barium enema

50. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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
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)
No and yes