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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. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
low in serum
C3 decreased after 5-10 days; sulfonamides
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

2. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
The time interval between S2 and OS- the shorter the interval - the more intense
No (unlike adenomyosis); yes
Chorda tympani branch

3. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Increases cytokine production
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

4. What is the presentation of sever aortic stenosis?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Drink plenty of fluids
No; MRI
Syncope - angina - dyspnea (SAD)

5. What does the severity of leprosy depend on?
High potassium conductance and some sodium conductance
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Classical conditioning
Strength of cell mediated immune response

6. What is the neurologic manifestation of ADPKD?
frameshift mutations (missense is substitution)
Decreases both
<1% - 55% - concentration dependent
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

7. What are some side effects seen in TCAs?
Trauma to stereociliated hair cells of the organ of corti
11
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Initiation - pointing; pincer grasp; walking; mama/dada

8. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Increase lymphatic drainage!
G to T in p53; HCC

9. what happens to capacitance with age?
Cluster
S. saprophyticus - and s. epidermidis; novobiocin
Because gamma chains replace beta chains and then gamma chain formation wanes
...

10. What are two indicators of chronic alcohol consumption?
Hypertension - edema - and proteinuria
In ER of bile canaliculi
Elevated GGT and macrocytosis
Hydrogen bonds dictate alpha or beta structure

11. what virus causes pharyngoconjuctival fever?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Anti centromere; anti DNA topoisomerase
Valproate
Adeno

12. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
E. coli; staphylococcus saprophyticus
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

13. which nerve provides innervation for plantar flexion and inversion?
I is more benign and can present later in adulthood
Tibial
46 - 4N; 23 2N
Recurrent larygneal

14. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Diabetic microangiopathy
SSRI
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Well

15. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Because of vasodiation to skeletal muscles
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
DIC; TTP- HUS dont bleed that much
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

16. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
4 - 4 - 9
Insulin like growth factor 1 (just another name)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

17. which antiarrythmic is associated with blue gray discoloration ?
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
Amiadarone
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
TSh (in testicular tumors can cause hyperthyroidism)

18. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Extrinsic def; instrinsic def; platelet def
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
8; 12
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)

19. What type of disease has selective proteinuria? What is found in urine? What is not?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Vagus nerve stimulation
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Atrial

20. what bursa is affected when on knees like a maid/gardner?
Integration of viral DNA into genome of host hepatocytes
Prepatellar
Fibrosis; macrophages
Increase; decreased

21. What is a keloid?
Medial circumflex artery; avascular necrosis
Kallmans
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Excessive collagen formation during tissue repair in susceptible individuals

22. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Appetite suppressants
Radial nerve damage

23. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Serum creatine kinase; reperfusion injury causes necrosis
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
Standing suddenly from supine position; valsalva maneuver

24. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Decreases both
Intussusception
Little effect on cell and no change

25. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
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
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Inhaled animal dander allergens

26. what enzyme converts procarcinogens into carcinogens?
Dihydropyridine sensitive Ca channels (L type)
Both sides
P450 mitochondrial monooxygenase
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

27. what immune deficiency causes recurrent neisseria infections?
Covalent (between two cysteines)- allows protein to withstand denaturation
MAC complex (C5b - C9 complement deficiency)
Anti centromere; anti DNA topoisomerase
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

28. When does opening snap begin?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Right before diastole (filling begins)
INTRApartum Abs (ampicillin/penicillin)
Susceptible; soluble (unable to be cultured in bile)

29. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Covalent (between two cysteines)- allows protein to withstand denaturation
Multiple miscarriages d/t hypercoaguability
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
200-500

30. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Anti centromere; anti DNA topoisomerase
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Medullary

31. What is the precursor protein to beta amyloid and On what chromosome is it found?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
APP on chrom 21 (this is why downs more susceptible)
Hypothyroidism

32. What are two common side effects of both acute and long acting nitrates? What causes them?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Elevated GGT and macrocytosis
Headaches and facial flushing; vasodilation in meninges and skin
Increases bronchial and vascular smooth muscle reactivity to catecholamines

33. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Because gamma chains replace beta chains and then gamma chain formation wanes

34. at 2 years of age - What are the social - fine motor - gross motor and language developments?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Downs; regurgitant AV valves - ASDs
Measles and M3 AML`

35. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Prevent phagocytosis
Reiter syndrome; B27

36. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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)
facultative intracellular
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

37. How is dobutamine better than dopamine?
hyponatremia (aldosterone activation equilibrates body volume)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Elevated GGT and macrocytosis

38. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
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
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
transcription activation/suppression

39. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Bronchial dilation (bronchiectasis)
Sarcoid
hyponatremia (aldosterone activation equilibrates body volume)

40. How do bradykinin - C3a and C5a cause edema?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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)
By vascular permeability and vasodilation

41. What is the most common location of colonization of all s. aureus types?
The term used to describe decreased drug responsiveness with repeated administration
FGF and VEGF
Elevated GGT and macrocytosis
Anterior nares

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

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43. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
By vascular permeability and vasodilation
women
Multiple miscarriages d/t hypercoaguability

44. in the LV and aorta - What are the pressures?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Normally close to systolic
Biphosphonate
Nocardia

45. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Myasthenia gravis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

46. What can cause virilization of a mother during pregnancy?
Southern - western
Aromatase deficiency in child
Curlings ulcers
Radial nerve damage

47. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Hypertension - edema - and proteinuria
No
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Primary

48. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Curlings ulcers
V fib; v. failure
8; 12

49. how can HAV be inactivated?
Fat - fertile - forty - female
...
Proteasome inhibitor; treatment for MM and waldenstroms
Boiling - bleach - formalin - UV irradiation

50. What can cause aortic regurg? What is the heart sound you hear?
indomethacin
SVT; increases vagal tone; rectus abdominis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Phase 4 (sodium current); reducing the rate of spontaneous depolarization