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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 are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Curlings ulcers
Elevated GGT and macrocytosis
4 - 4 - 9

2. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Become beta pleated and then form neurofibrillary tangle!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

3. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
No; yes
S. aureus
Little effect on cell and no change

4. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Because of vasodiation to skeletal muscles
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)
Syringomelia
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

5. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Another type of aldosterone antagonist (like spironolactone)
V fib; v. failure
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

6. what drug is useful for secretory diarrhea?
Fat - fertile - forty - female
INTRApartum Abs (ampicillin/penicillin)
Octreotide
Measure of depth invasion (vertical!)

7. What would a deflection of the membrane potential to near zero indicate?
In the extracellular space for collagen cross linking; zinc
Increase in permeability of two ions with equal and opposite equilibrium potentials
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Vagus (auricular branch); vasovagal syncope!

8. What is omalizumab and What is it used for?
<1% - 55% - concentration dependent
HSV ( also in utero: chlymadia - neisseria - group B strep)
Fibrosis; macrophages
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

9. 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?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Lateral; RV; RA; LV
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
Rabies encephalitis from cave bats; rabies killed vaccines

10. What is the immune deficinecy seen in ataxia telangactasia?
...
Varying; erythema nodosum is common
Ig A deficiency
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

11. what kind of drug is sertraline? What is a common side effect?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
P450 mitochondrial monooxygenase
Hypertension - edema - and proteinuria
SSRI; erectile dysfunction

12. What is the diagnosis in delayed puberty plus anosmia?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Kallmans
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

13. what chromosome is c - myc found on?
Chrom 8
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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
Skin flushing and warmth; prostaglandins; give with aspirin

14. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Leukotriene precursor and does neutrophil chemotaxis
Vascular endothelium; protease
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

15. What is hypospadias caused by?
11
Abnormal closing of the urethral folds
Neisseria induced small cell vasculitis (including hands and soles)
Tzanck smear

16. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Congenital hypothyroidism - downs - amyloidosis - acromegaly
GI malignancies and Insulin resistance (acromegal for ex)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

17. in the LV and aorta - What are the pressures?
Large stroke volumes with ventricular contraction; aortic regurg
P53 mutation; AD
S. aureus
Normally close to systolic

18. What is the cause of fixed splitting of S2? why?
Drug induced interstitial nephritis
Medial part
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

19. What is the presentation of sever aortic stenosis?
Chorda tympani branch
Syncope - angina - dyspnea (SAD)
Tzanck smear
E. coli; staphylococcus saprophyticus

20. What does nitroprusside do to afterload? preload?
Decreases both
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Localized dermatologic pain that persists for more than one month after zoster eruption
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

21. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Fibronectin - laminin - collagen
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
TSh (in testicular tumors can cause hyperthyroidism)

22. are there signs of inflammation in avascular necrosis? then How do you diagnose?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
No; MRI
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

23. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Increases cytokine production
manifestations - congenital (stretching of periventricular pyrimadal fibers)
...
No; MRI

24. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hydrogen bonds dictate alpha or beta structure
Hypo or hyper pigmentations; after tanning
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

25. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Chlorpheniramine and diphenhydramine
Retinitis; mononucleosis

26. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
200-500
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Anterior nares
Faulty positioning of the genital tubercle

27. What is Bortezomib and What is it used for?
Anterior circumflex (and axillary nerve)
Proteasome inhibitor; treatment for MM and waldenstroms
Bronchial dilation (bronchiectasis)
Chorda tympani branch

28. What can cause virilization of a mother during pregnancy?
In the extracellular space for collagen cross linking; zinc
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Covalent (between two cysteines)- allows protein to withstand denaturation
Aromatase deficiency in child

29. When is acid phosphatase elevated (Name two times)?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Brief psychotic disorder; schizophreniform; schizophrenia
Phencyclidine (PCP)
Prostate tumor and increased osteoclast activity

30. What does NF- KB do?
Atrial
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Increases cytokine production

31. do Class IC agents prolong the QT interval?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Vertical diplopia
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
No

32. which trisomy is associated with endocardial cushion defects? What does thsi mean>
RBF= PAH clearance/(1- hematocrit)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Downs; regurgitant AV valves - ASDs
S3 gallop; S2 to opening snap interval

33. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Mean greater than median greater than mode
differentiate

34. Which is faster atrial muscle or ventricular muscle?
Think Hb deformation diseases
Atrial
Right heart failure
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose

35. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Dihydropyridine sensitive Ca channels (L type)
chronic urticaria and allergic symptoms
transcription activation/suppression

36. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Anterior circumflex (and axillary nerve)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Tissue redistribution (out of plasma) rather than metabolism

37. What does Rb protein do? what chrom is it on?
No; MRI
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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

38. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
On cardiac tissue and renal juxtaglomerular cells
Little effect on cell and no change
CGD; t cell dysfxn (diGeorge)

39. 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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40. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
CMV - HSV 1 - Candida
Because of the low output from heart failure - they will have increased aldosterone levels

41. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
facultative intracellular
Retinitis; mononucleosis

42. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Extrinsic def; instrinsic def; platelet def
Because of the low output from heart failure - they will have increased aldosterone levels
NF- KB; responsible for cytokine production

43. What is subacute sclerosisng encephalitis caused by?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Sydenham chorea
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
Covalent (between two cysteines)- allows protein to withstand denaturation

44. What is the most common neurologic complication of VZV reactivation?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Turbulence
Localized dermatologic pain that persists for more than one month after zoster eruption
women

45. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Prepatellar
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
Increased reticulocytes

46. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Medial part
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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

47. Metronidizaole does not cover...
4 - 4 - 9
gram positive organisms
Initiation - pointing; pincer grasp; walking; mama/dada
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

48. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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

49. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
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
Fat - fertile - forty - female
When it invades the bm; carcinoma in situ
Right heart failure

50. What is gardeners mydriasis? How is it treated?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Because gamma chains replace beta chains and then gamma chain formation wanes
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus